title: Visceral leishmaniasis and HIV coinfection in the Mediterranean region.
abstract: Visceral leishmaniasis is hypoendemic in Mediterranean countries, where it is caused by the flagellate protozoan Leishmania infantum. VL cases in this area account for 5%-6% of the global burden. Cases of Leishmania/HIV coinfection have been reported in the Mediterranean region, mainly in France, Italy, Portugal, and Spain. Since highly active antiretroviral therapy was introduced in 1997, a marked decrease in the number of coinfected cases in this region has been reported. The development of new diagnostic methods to accurately identify level of parasitemia and the risk of relapse is one of the main challenges in improving the treatment of coinfected patients. Clinical trials in the Mediterranean region are needed to determine the most adequate therapeutic options for Leishmania/HIV patients as well as the indications and regimes for secondary prophylaxis. This article reviews the epidemiological, diagnostic, clinical, and therapeutic aspects of Leishmania/HIV coinfection in the Mediterranean region.
authors.affiliation: Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Monge-Maillo
authors.affiliation: Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Francesca F
authors.initials: FF
authors.lastname: Norman
authors.affiliation: WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Israel
authors.initials: I
authors.lastname: Cruz
authors.affiliation: Visceral Leishmaniasis Program, Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland.
authors.forename: Jorge
authors.initials: J
authors.lastname: Alvar
authors.affiliation: Tropical Medicine & Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000453:epidemiology*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007371:Interferon-gamma / Q000096:biosynthesis; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D019083:Mediterranean Region / Q000453:epidemiology; D016133:Polymerase Chain Reaction
chemical_list: D007371:Interferon-gamma