The Brazilian Journal of Infectious Diseases The Brazilian Journal of Infectious Diseases
Braz J Infect Dis 2018;22:92-8 - Vol. 22 Num.2 DOI: 10.1016/j.bjid.2018.03.001
Original article
Is Visceral Leishmaniasis the same in HIV-coinfected adults?
Guilherme Alves de Lima Henna,b,, , Alberto Novaes Ramos Júniorb, Jeová Keny Baima Colaresc,d, Lorena Pinho Mendesc, João Gabriel Colares Silveirae, Anderson Alberto Façanha Limae, Bárbara Pontes Airesf, Mônica Cardoso Façanhab
a Universidade Federal do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil
b Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brazil
c Secretaria de Saúde do Estado do Ceará, Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil
d Universidade de Fortaleza, Faculdade de Medicina, Fortaleza, CE, Brazil
e Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brazil
f Universidade Estadual do Ceará, Faculdade de Medicina, Fortaleza, CE, Brazil
Received 13 October 2017, Accepted 08 March 2018
Abstract
Introduction

Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection.

Methods

We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza – Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period.

Results

Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment.

Conclusions

Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.

Keywords
Leishmaniasis, HIV, Coinfection
Braz J Infect Dis 2018;22:92-8 - Vol. 22 Num.2 DOI: 10.1016/j.bjid.2018.03.001