Prevalence of and factors associated with visceral leishmaniasis in human immunodeficiency virus type 1-infected patients in southern Spain.
The actual prevalence of visceral leishmaniasis among human immunodeficiency type 1 (HIV-1)-infected patients in the Mediterranean basin remains unknown. There is also controversy about the risk factors for Leishmania infantum and HIV-1 coinfection. To appraise the prevalence of visceral leishmaniasis in patients infected with HIV-1 in southern Spain and to identify factors associated with this disease, 291 HIV-1 carriers underwent a bone marrow aspiration, regardless of their symptoms. Giemsa-stained samples were searched for Leishmania amastigotes. Thirty-two (11%) patients showed visceral leishmaniasis. Thirteen (41%) patients had subclinical cases of infection. Centers for Disease Control and Prevention (CDC) clinical category C was the factor most strongly associated with this disease (adjusted odds ratio [OR], 1.88 [95% confidence interval, 1.22 to 2.88]), but patients with subclinical cases of infection were found in all CDC categories. Female sex was negatively associated with visceral leishmaniasis (adjusted OR, 0.42 [95% confidence interval, 0.18 to 0.97]). Intravenous drug users showed a higher prevalence than the remaining patients (13.3 versus 4.9%; P = 0.04), but such an association was not independent. These results show that visceral leishmaniasis is a very prevalent disease among HIV-1-infected patients in southern Spain, with a high proportion of cases being subclinical. Like other opportunistic infections, subclinical visceral leishmaniasis can be found at any stage of HIV-1 infection, but symptomatic cases of infection appear mainly when a deep immunosuppression is present. There is also an association of this disease with male sex and intravenous drug use.
Pineda
J A
JA
Viral Hepatitis and AIDS Study Group, Hospital Universitario Virgen del Rocío, 41013-Seville, Spain. vergara@cica.es
Gallardo
J A
JA
Macías
J
J
Delgado
J
J
Regordán
C
C
Morillas
F
F
Relimpio
F
F
Martín-Sánchez
J
J
Sánchez-Quijano
A
A
Leal
M
M
Lissen
E
E
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000469:parasitology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D018791:CD4 Lymphocyte Count; D002353:Carrier State; D003710:Demography; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology / Q000469:parasitology; D015497:HIV-1; D006801:Humans; D018314:Leishmania infantum; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013030:Spain / Q000453:epidemiology