title: Leptospirosis and human immunodeficiency virus co-infection among febrile inpatients in northern Tanzania.
abstract: BACKGROUND
  Leptospirosis and human immunodeficiency virus (HIV) infection are prevalent in many areas, including northern Tanzania, yet little is known about their interaction.
  
  
  METHODS
  We enrolled febrile inpatients at two hospitals in Moshi, Tanzania, over 1 year and performed HIV antibody testing and the microscopic agglutination test (MAT) for leptospirosis. Confirmed leptospirosis was defined as ≥ four-fold rise in MAT titer between acute and convalescent serum samples, and probable leptospirosis was defined as any reciprocal MAT titer ≥ 800.
  
  
  RESULTS
  Confirmed or probable leptospirosis was found in 70 (8.4%) of 831 participants with at least one serum sample tested. At total of 823 (99.0%) of 831 participants had HIV testing performed, and 203 (24.7%) were HIV infected. Among HIV-infected participants, 9 (4.4%) of 203 had confirmed or probable leptospirosis, whereas among HIV-uninfected participants 61 (9.8%) of 620 had leptospirosis. Leptospirosis was less prevalent among HIV-infected as compared to HIV-uninfected participants [odds ratio (OR) 0.43, p=0.019]. Among those with leptospirosis, HIV-infected patients more commonly presented with features of severe sepsis syndrome than HIV-uninfected patients, but differences were not statistically significant. Among HIV-infected patients, severe immunosuppression was not significantly different between those with and without leptospirosis (p=0.476). Among HIV-infected adolescents and adults, median CD4 percent and median CD4 count were higher among those with leptospirosis as compared to those with other etiologies of febrile illness, but differences in CD4 count did not reach statistical significance (p=0.015 and p=0.089, respectively).
  
  
  CONCLUSIONS
  Among febrile inpatients in northern Tanzania, leptospirosis was not more prevalent among HIV-infected patients. Although some indicators of leptospirosis severity were more common among HIV-infected patients, a statistically significant difference was not demonstrated. Among HIV-infected patients, those with leptospirosis were not more immunosuppressed relative to those with other etiologies of febrile illness.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Biggs
authors.forename: Renee L
authors.initials: RL
authors.lastname: Galloway
authors.forename: Duy M
authors.initials: DM
authors.lastname: Bui
authors.forename: Annie B
authors.initials: AB
authors.lastname: Morrissey
authors.forename: Venance P
authors.initials: VP
authors.lastname: Maro
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000907:Antibodies, Bacterial / Q000276:immunology*; D000914:Antibodies, Viral / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D005260:Female; D005334:Fever; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000276:immunology* / Q000302:isolation & purification; D015498:HIV-2 / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007297:Inpatients; D007919:Leptospira / Q000276:immunology* / Q000302:isolation & purification; D007922:Leptospirosis / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral