Visceral Leishmaniasis in Hospitalized HIV-Infected Patients in Pernambuco, Brazil

Diego Lins Guedes Curso de Medicina, Núcleo de Ciências da Vida, Universidade Federal de Pernambuco, Caruaru, Brazil;
Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil;

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Zulma Medeiros Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil;
Instituto de Ciências Biológicas, Universidade de Pernambuco, Recife, Brazil;

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Elis Dionísio da Silva Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil;

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Audrey Violeta Martins de Vasconcelos Fundação de Hematologia e Hemoterapia de Pernambuco, Recife, Brazil;

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Mariana Santana da Silva Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil;

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Maria Almerice Lopes da Silva Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil;

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Paulo Sérgio Ramos de Araújo Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil;

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Demócrito de Barros Miranda-Filho Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil

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Common in four continents, visceral leishmaniasis (VL) is an important but neglected disease. Human immunodeficiency virus (HIV) infection increases the risk of developing VL in people from leishmaniasis-endemic areas, with worse prognosis when there is coinfection. We conducted a cross-sectional study to determine the prevalence of HIV/VL coinfection in patients admitted in three referral hospitals for HIV/acquired immunodeficiency syndrome (AIDS) in Pernambuco, Brazil, and to compare epidemiological, clinical, and laboratory characteristics among HIV/VL coinfected and HIV mono-infected individuals. The sample consisted of HIV patients aged 18 years or more, in a period of data collection of 6 months. We performed four Leishmania tests—polymerase chain reaction (PCR), direct agglutination test, rK39, and latex agglutination test—and individuals with at least one positive test were considered coinfected. The HIV/VL coinfection prevalence we found was 16.9%. We observed large variation in prevalence according to the Leishmania test used, with low coincidence of positive tests. The most frequent symptoms found were weight loss (75.6%), fever (67.6%), and cough (55.3%). When we compared HIV/VL coinfected and HIV mono-infected groups we did not observe statistically significant differences. Low educational level (P = 0.004) and pallor (P = 0.009) were more frequent in the coinfected group. Serum albumin level was higher in coinfected individuals (P = 0.009). It is important to follow-up these individuals to understand the dynamics of VL in people living with HIV. New tests are necessary, ideally differentiating active from latent infection. Testing for VL in people with HIV is important and should be considered as part of the initial investigation in these individuals.

Author Notes

Address correspondence to Diego Lins Guedes, Curso de Medicina, Universidade Federal de Pernambuco, Rodovia BR-104, Km 59, s/n–Nova Caruaru, Caruaru 55002-970, Brazil. E-mail: diego.linsguedes@ufpe.br

Financial support: Support was provided by Fundação de Amparo à Ciência e Tecnologia do Estado de Pernambuco (APQ-1284-4.01/08, 0052-4.00/13, and 1712-4.01/15). The authors received partial support from the Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq (Scholarship 308590/2013-9 to D. B. M. F., 104573/2014-7 to M. S. S.).

Authors’ addresses: Diego Lins Guedes, Curso de Medicina, Núcleo de Ciências da Vida, Universidade Federal de Pernambuco, Caruaru, Brazil, E-mail: diego.linsguedes@ufpe.br. Zulma Medeiros, Elis Dionísio da Silva, Mariana Santana da Silva, Maria Almerice Lopes da Silva, and Paulo Sérgio Ramos de Araújo, Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil, E-mails: medeiros@cpqam.fiocruz.br, dionisio.elis@gmail.com, marianasantanape@gmail.com, almerice@cpqam.fiocruz.br, and psergiora@gmail.com. Audrey Violeta Martins de Vasconcelos, Fundação de Hematologia e Hemoterapia de Pernambuco, Recife, Brazil, E-mail: audrey_marcelino@hotmail.com. Demócrito de Barros Miranda-Filho, Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil, E-mail: demofilho@gmail.com.

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