title: Clinical characteristics and treatment outcome of patients with visceral leishmaniasis and HIV co-infection in northwest Ethiopia.
abstract: OBJECTIVE
  To describe the clinical presentation of patients with visceral leishmaniasis (VL) with and without human immunodeficiency virus (HIV) co-infection and factors associated with poor outcome in northwest Ethiopia.
  
  
  METHODS
  Retrospective review of 241 patients with VL (92 with and 149 without HIV co-infection).
  
  
  RESULTS
  HIV co-infection was present in 92 (38%) of the patients. Clinical presentation of VL was indistinguishable between patients with and without HIV co-infection. Co-infected patients had a poorer outcome i.e. either death or treatment failure (31.5%vs. 5.6%, P < 0.001). The presence of tuberculosis or sepsis syndrome among patients with VL and HIV co-infected independently predicted death or treatment failure [odds ratio 4.5 (95% CI 1.47-13.92, P = 0.009) and 9.1 (95% CI 2.16-37.97, P = 0.003), respectively]. Despite having similar clinical presentation at the time of diagnosis, VL and HIV co-infected patients had a higher mortality and treatment failure than immunocompetent patients.
  
  
  CONCLUSIONS
  The frequency of HIV co-infection among patients with VL is high in the study area, and this co-infection was associated with death or treatment failure. The clinical management of VL in HIV co-infected patients is a major challenge that requires new treatment approaches to improve its outcome.
authors.affiliation: University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia. hurzew@yahoo.com
authors.forename: Zewdu
authors.initials: Z
authors.lastname: Hurissa
authors.forename: Samuel
authors.initials: S
authors.lastname: Gebre-Silassie
authors.forename: Workagegnehu
authors.initials: W
authors.lastname: Hailu
authors.forename: Tewodros
authors.initials: T
authors.lastname: Tefera
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: Luis E
authors.initials: LE
authors.lastname: Cuevas
authors.forename: Asrat
authors.initials: A
authors.lastname: Hailu
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents