Author | Cota, Gláucia Fernandes | |
Author | Sousa, Marcos Roberto de | |
Author | Mendonça, Andrea Laender Pessoa de | |
Author | Patrocinio, Allan | |
Author | Assunçao, Luiza Siqueira | |
Author | Faria, Sidnei Rodrigues de | |
Author | Rabello, Ana Lucia Teles | |
Access date | 2015-02-19T15:28:58Z | |
Available date | 2015-02-19T15:28:58Z | |
Document date | 2014 | |
Citation | COTA, Gláucia Fernandes et al. Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil. PLoS Neglected Tropical Diseases, v. 8, n. 4, p. 1-7, Apr. 2014. | pt_BR |
ISSN | 1935-2735 | |
URI | https://www.arca.fiocruz.br/handle/icict/9501 | |
Language | eng | pt_BR |
Publisher | Public Library of Science | pt_BR |
Rights | open access | pt_BR |
Title | Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil | pt_BR |
Type | Article | pt_BR |
DOI | 10.1371/journal.pntd.0002816 | |
Abstract | BACKGROUND: Visceral leishmaniasis (VL) is an emerging condition affecting HIV-infected patients living in Latin America, particularly in Brazil. Leishmania-HIV coinfection represents a challenging diagnosis because the clinical picture of VL is similar to that of other disseminated opportunistic diseases. Additionally, coinfection is related to treatment failure, relapse and high mortality. OBJECTIVE: To assess the clinical-laboratory profile and outcomes of VL-HIV-coinfected patients using a group of non HIV-infected patients diagnosed with VL during the same period as a comparator. METHODS: The study was conducted at a reference center for infectious diseases in Brazil. All patients with suspected VL were evaluated in an ongoing cohort study. Confirmed cases were divided into two groups: with and without HIV coinfection. Patients were treated according to the current guidelines of the Ministry of Health of Brazil, which considers antimony as the first-choice therapy for non HIV-infected patients and recommends amphotericin B for HIV-infected patients. After treatment, all patients with CD4 counts below 350 cells/mm3 received secondary prophylaxis with amphotericin B. RESULTS: Between 2011 and 2013, 168 patients with suspected VL were evaluated, of whom 90 were confirmed to have VL. In total, 51% were HIV coinfected patients (46 patients). HIV-infected patients had a lower rate of fever and splenomegaly compared with immunocompetent patients. The VL relapse rate in 6 months was 37% among HIV-infected patients, despite receiving secondary prophylaxis. The overall case-fatality rate was 6.6% (4 deaths in the HIV-infected group versus 2 deaths in the non HIV-infected group). The main risk factors for a poor outcome at 6 months after the end of treatment were HIV infection, bleeding and a previous VL episode. CONCLUSION: Although VL mortality rates among HIV-infected individuals are close to those observed among immunocompetent patients treated with amphotericin B, HIV coinfection is related to a low clinical response and high relapse rates within 6 months. | pt_BR |
Affilliation | Fundaçao Oswaldo Cruz. Centro de Pesquisas Rene Rachou. Laboratório de Pesquisas Clinicas. Belo Horizonte, MG, Brasil / Fundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, Brasil. | pt_BR |
Affilliation | Universidade Federal de Minas Gerais. Programa de Pós Graduação em Ciências da Saúde. Belo Horizonte, Minas Gerais, Brasil. | pt_BR |
Affilliation | Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil. | pt_BR |
Affilliation | Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil. | pt_BR |
Affilliation | Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil. | pt_BR |
Affilliation | Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Centro de Pesquisas Rene Rachou. Laboratório de Pesquisas Clinicas. Belo Horizonte, MG, Brasil. | pt_BR |
Subject | Brazil | pt_BR |
Subject | Coinfection | pt_BR |
Subject | Coinfection | pt_BR |
Subject | Leishmaniasis Visceral | pt_BR |
Subject | HIV Infections | pt_BR |
Subject | Epidemiology | pt_BR |
Subject | Complications | pt_BR |