[The clinical and evolutional characteristics of visceral leishmaniasis in patients with HIV infection].
OBJECTIVE
To analyze the clinical features, yield of the diagnostic techniques, and therapeutic response of HIV-associated visceral leishmaniasis (VL), and compare the initial episodes to the relapses.


METHODS
Forty-one episodes of leishmaniasis visceral, diagnosed in 31 HIV-positive patients between 1st February 1992 and 31st January 1996 were reviewed.


RESULTS
The prevalence of VL in HIV-positive patients in our center was 4.2%. Fifty-eight percent of the patients had AIDS prior to the diagnosis of VL. Fever was more frequent in the initial episodes than in the relapses (90.3% versus 60%; p < 0.05; OR: 6.2; IC 95%: 0.8-51.5), splenomegaly was more frequent in the relapses (100% versus 71%; p = 0.05). The diagnostic delay was longer in the initial episodes (27.2 +/- 22.7 versus 5 +/- 4.8 days; p < 0.05). The diagnostic yield of bone marrow biopsy was 82.1%, of liver biopsy 72.7% and of splenic fine-needle aspiration 87.5%. The indirect immunofluorescence test for Leishmania antibodies was positive in 5.9% of cases. Therapeutic failure occurred in 47.6% of patients treated with antimonials and 3.3% of patients treated with amphotericin B. Those patients who received secondary prophylaxis had less relapses than those who did not (17.6% versus 66.7%; p < 0.05; OR: 0.11; IC 95%: 0.01-1.28). Of the 31 patients, twenty-six (83.8%) died, and in none of them was the cause of the death directly related to LV.


CONCLUSIONS
HIV-associated VL manifests clinically in a similar fashion to the immunocompetent's disease. It appears in advanced immunosuppression phases, behaving like other AIDS-defining illnesses. In spite of a good therapeutic response the relapse rate is high.
Delgado Fernández
M
M
Departamento de Medicina Interna, Hospital Regional Carlos Haya, Málaga.
García Ordoñez
M A
MA
Martos Pérez
F
F
Reguera Iglesias
J M
JM
Jiménez Oñate
F
F
Colmenero Castillo
J D
JD
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D000493:Allopurinol / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D015497:HIV-1; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D015995:Prevalence; D012008:Recurrence; D013030:Spain / Q000453:epidemiology
D000981:Antiprotozoal Agents; D000493:Allopurinol; D000666:Amphotericin B