title: Slow clinical improvement after treatment initiation in Leishmania/HIV coinfected patients.
abstract: BACKGROUND
  In Brazil there is a large area of overlap of visceral leishmaniasis (VL) and HIV infection, which favored a increased incidence of coinfection Leishmania/HIV.
  
  
  METHODS
  This study evaluated 65 consecutive patients with VL and their clinical response to treatment in two health care settings in Belo Horizonte, Brazil.
  
  
  RESULTS
  At baseline, the clinical picture was similar between both groups, although diarrhea and peripheral lymphadenomegaly were more frequent in HIV-infected subjects. HIV-positive patients had lower median blood lymphocyte counts (686/mm³ versus 948/mm³p = 0.004) and lower values of alanine aminotransferase (ALT) (48IU/L versus 75.6IU/L p = 0.016) than HIV-negative patients. HIV-positive status (hazard ratio = 0.423, p = 0.023) and anemia (HR = 0.205, p = 0.002) were independent negative predictors of complete clinical response following antileishmanial treatment initiation.
  
  
  CONCLUSIONS
  This study reinforces that all patients with VL should be tested for HIV infection, regardless of their clinical picture. This practice would allow early recognition of coinfection with initiation of antiretroviral therapy and, possibly, reduction in treatment failure.
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG.
authors.forename: Guenael Freire de
authors.initials: GF
authors.lastname: Souza
authors.forename: Fernando
authors.initials: F
authors.lastname: Biscione
authors.forename: Dirceu Bartolomeu
authors.initials: DB
authors.lastname: Greco
authors.forename: Ana
authors.initials: A
authors.lastname: Rabello
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy*; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008297:Male; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents