title: Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil.
abstract: BACKGROUND
  Visceral leishmaniasis (VL) is an emerging condition affecting HIV-infected patients living in Latin America, particularly in Brazil. Leishmania-HIV coinfection represents a challenging diagnosis because the clinical picture of VL is similar to that of other disseminated opportunistic diseases. Additionally, coinfection is related to treatment failure, relapse and high mortality.
  
  
  OBJECTIVE
  To assess the clinical-laboratory profile and outcomes of VL-HIV-coinfected patients using a group of non HIV-infected patients diagnosed with VL during the same period as a comparator.
  
  
  METHODS
  The study was conducted at a reference center for infectious diseases in Brazil. All patients with suspected VL were evaluated in an ongoing cohort study. Confirmed cases were divided into two groups: with and without HIV coinfection. Patients were treated according to the current guidelines of the Ministry of Health of Brazil, which considers antimony as the first-choice therapy for non HIV-infected patients and recommends amphotericin B for HIV-infected patients. After treatment, all patients with CD4 counts below 350 cells/mm3 received secondary prophylaxis with amphotericin B.
  
  
  RESULTS
  Between 2011 and 2013, 168 patients with suspected VL were evaluated, of whom 90 were confirmed to have VL. In total, 51% were HIV coinfected patients (46 patients). HIV-infected patients had a lower rate of fever and splenomegaly compared with immunocompetent patients. The VL relapse rate in 6 months was 37% among HIV-infected patients, despite receiving secondary prophylaxis. The overall case-fatality rate was 6.6% (4 deaths in the HIV-infected group versus 2 deaths in the non HIV-infected group). The main risk factors for a poor outcome at 6 months after the end of treatment were HIV infection, bleeding and a previous VL episode.
  
  
  CONCLUSIONS
  Although VL mortality rates among HIV-infected individuals are close to those observed among immunocompetent patients treated with amphotericin B, HIV coinfection is related to a low clinical response and high relapse rates within 6 months.
authors.affiliation: Laboratory of Clinical Research - Centro de Pesquisas René Rachou - Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil; Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Gláucia F
authors.initials: GF
authors.lastname: Cota
authors.affiliation: Post-Graduate Program in Adult Health Sciences - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Marcos R
authors.initials: MR
authors.lastname: de Sousa
authors.affiliation: Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Andrea Laender Pessoa
authors.initials: AL
authors.lastname: de Mendonça
authors.affiliation: Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Allan
authors.initials: A
authors.lastname: Patrocinio
authors.affiliation: Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Luiza Siqueira
authors.initials: LS
authors.lastname: Assunção
authors.affiliation: Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Sidnei Rodrigues
authors.initials: SR
authors.lastname: de Faria
authors.affiliation: Laboratory of Clinical Research - Centro de Pesquisas René Rachou - Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil.
authors.forename: Ana
authors.initials: A
authors.lastname: Rabello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D018890:Chemoprevention / Q000379:methods; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents
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