Visceral leishmaniasis in HIV-1-infected individuals: a common opportunistic infection in Spain?
OBJECTIVE
To investigate the epidemiological, clinical and biological features of visceral leishmaniasis (VL) in patients with HIV-1 infection.


METHODS
Retrospective study.


METHODS
Three university hospitals in southern Spain.


METHODS
Forty-seven adult patients with VL and HIV-1 infection diagnosed between January 1986 and November 1991.


RESULTS
Forty-five out of the 47 (96%) cases were diagnosed in the last 2 years. Fever (87%), hepatomegaly (74%), splenomegaly (72%) and pancytopenia (77%) were the most common presenting features. Most patients (79%) were strongly immunocompromised when VL was diagnosed, and were in stage IV of the Centers for Disease Control classification; 87% had a CD4 lymphocyte count < 200 x 10(6)/l. However, VL was the first severe infection diagnosed in 10 cases. Significant titres (> 1:40) of antileishmanial antibodies were detected by indirect immunofluorescence in five out of 16 (31%) cases only. Clinical response to the therapy was difficult to assess. Microbiological response was achieved in only 38% of the patients evaluated.


CONCLUSIONS
Leishmaniasis is a relatively common infection in HIV-1-infected individuals in southern Spain. Its clinical picture is quite uniform and it can be the first opportunistic infection in individuals with HIV-1. In endemic areas, a high index of clinical suspicion should be maintained in order to avoid underdiagnosis of leishmaniasis.
Medrano
F J
FJ
Viral Hepatitis and AIDS Study Group, Virgen del Rocio University Hospital, Sevilla, Spain.
Hernández-Quero
J
J
Jiménez
E
E
Pineda
J A
JA
Rivero
A
A
Sánchez-Quijano
A
A
Velez
I D
ID
Viciana
P
P
Castillo
R
R
Reyes
M J
MJ
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D015497:HIV-1 / Q000276:immunology; D006785:Hospitals, University; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000627:therapeutic use; D010419:Pentamidine / Q000627:therapeutic use; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D000493:Allopurinol; D010419:Pentamidine; D008536:Meglumine; D000077485:Meglumine Antimoniate