Visceral leishmaniasis in Northeast Brazil: What is the impact of HIV on this protozoan infection?
Autoři:
Uiara Regina Silva de Lima aff001; Luciano Vanolli aff002; Elizabeth Coelho Moraes aff002; Jorim Severino Ithamar aff003; Conceição de Maria Pedrozo e Silva de Azevedo aff001
Působiště autorů:
Post-graduation Program of Health Science, Federal University of Maranhão, São Luís, MA, Brazil
aff001; Medicine Graduate Program, Federal University of Maranhão, São Luís, MA, Brazil
aff002; President Vargas Hospital, São Luís, MA, Brazil
aff003; Department of Medicine, Federal University of Maranhão, São Luís, MA, Brazil
aff004
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225875
Souhrn
Background
The aim of this study was to compare cases of Visceral Leishmaniasis (VL) with and without HIV in a state in northeastern Brazil.
Methodology
We performed a comparative study in the state’s referral hospital for infectious/parasitic diseases located in Northeast Brazil between January 2007 and July 2017. The data obtained using this protocol were analyzed with SPSS.
Principal findings
In total, 252 patients were evaluated, including 126 with coincident VL/HIV and 126 with VL alone. Both groups primarily consisted of male patients. The most commonly affected ages were 30–39 years in the coinfected group and 19–29 years in the VL group (p < 0.001). Fever and anorexia (p = 0.001), which were more common in those with VL alone, were frequently observed, while diarrhea, vomiting, bleeding and dyspnea were more common in patients with VL/HIV coinfection (p<0.005). According to the hemogram results, leukocyte levels were lower in the VL group (p < 0.0001). Additionally, AST (aspartate aminotransferase) and ALT (alanine aminotransferase) levels differed between the groups, with higher levels in patients with VL (p < 0.001). On average, HIV was diagnosed 2.6 years before VL (p < 0.001), and VL relapse was observed only in the coinfection group (36.5% of cases). Fever (β = +0.17; p = 0.032) in the first VL/HIV episode was identified as a risk factor for relapse (R2 = 0.18). More deaths occurred in the VL/HIV group (11.1%) than in the VL group (2.4%).
Conclusion/Significance
VL/HIV was found to be prevalent among young adults, although the median patient age was higher in the VL/HIV group. The classic symptomatology of VL was more common in patients not coinfected with HIV; therefore, attention is needed in patients with HIV who present with any symptoms that suggest the presence of VL, especially in endemic areas. No cases of VL relapse occurred in patients without HIV, and death was more common in the VL/HIV co-infected group.
Klíčová slova:
HIV diagnosis and management – Fevers – Brazil – HIV epidemiology – Co-infections – Leishmaniasis – HIV clinical manifestations – Kala-azar
Zdroje
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