title: Impact of highly active antiretroviral therapy on the incidence of visceral leishmaniasis in a French cohort of patients infected with human immunodeficiency virus.
abstract: The incidence of human immunodeficiency virus (HIV)-Leishmania coinfections in France was estimated on the basis of the French Hospital Database on HIV, and risk factors for the occurrence of visceral leishmaniasis (VL) were analyzed by a multivariate Cox model. VL was diagnosed in 165 of 55,626 HIV-infected patients followed since 1992. The incidence of VL decreased from 11.6+/-1.2 per 10,000 persons-years before 1996 to 6.3+/-0.7 per 10,000 persons-years after 1996, the year when highly active antiretroviral therapy (HAART) was initiated in France. The relative hazard (RH) for development of VL was higher in (1) intravenous drug users versus other transmission groups (RH=1.56; 95% CI, 1.13-2.15), (2) patients living in southern France versus those living in northern France (RH=3.36; 95% CI, 2.44-4.61), and (3) patients who had a CD4 cell count of </=50/mm(3) during their follow-up versus those who did not (RH=6.45; 95% CI, 4.27-9.75) but was lower in (4) patients who received antiretroviral therapy including >/=3 drugs versus those who did not (RH=0.41; 95% CI, 0.26-0.65). We found a significant decrease in the incidence of HIV-Leishmania coinfections after 1996, associated with the introduction of HAART in France.
authors.affiliation: Unité de Maladies Infectieuses et Dermatologie, Hôpital Bonnet, Fréjus, France. del-giudice-p@chi-frejus-saint-raphael.fr
authors.forename: P
authors.initials: P
authors.lastname: del Giudice
authors.forename: M
authors.initials: M
authors.lastname: Mary-Krause
authors.forename: C
authors.initials: C
authors.lastname: Pradier
authors.forename: S
authors.initials: S
authors.lastname: Grabar
authors.forename: P
authors.initials: P
authors.lastname: Dellamonica
authors.forename: P
authors.initials: P
authors.lastname: Marty
authors.forename: J A
authors.initials: JA
authors.lastname: Gastaut
authors.forename: D
authors.initials: D
authors.lastname: Costagliola
authors.forename: E
authors.initials: E
authors.lastname: Rosenthal
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D015994:Incidence; D007898:Leishmaniasis, Visceral / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis
chemical_list: D019380:Anti-HIV Agents