Asymptomatic Leishmania infection in HIV-positive outpatients on antiretroviral therapy in Pernambuco, Brazil

PLoS Negl Trop Dis. 2021 Jan 21;15(1):e0009067. doi: 10.1371/journal.pntd.0009067. eCollection 2021 Jan.

Abstract

Background: Visceral leishmaniasis (VL) in HIV-positive individuals is a global health problem. HIV-Leishmania coinfection worsens prognosis and mortality risk, and HIV-Leishmania coinfected individuals are more susceptible to VL relapses. Early initiation of antiretroviral therapy can protect against Leishmania infection in individuals living in VL-endemic areas, and regular use of antiretrovirals might prevent VL relapses in these individuals. We conducted a cross-sectional study in Petrolina, Brazil, an VL-endemic area, to estimate the prevalence of asymptomatic Leishmania cases among HIV-positive outpatients.

Methods: We invited any HIV-positive patients, aged ≥ 18-years-old, under antiretroviral therapy, and who were asymptomatic for VL. Patients were tested for Leishmania with enzyme-linked immunosorbent assays (ELISA)-rK39, immunochromatographic test (ICT)-rK39, direct agglutination test (DAT), latex agglutination test (KAtex), and conventional polymerase chain reaction (PCR). HIV-Leishmania coinfection was diagnosed when at least one VL test was positive.

Results: A total of 483 patients were included. The sample was predominantly composed of single, < 48-years-old, black/pardo, heterosexual males, with fewer than 8 years of schooling. The prevalence of asymptomatic HIV-Leishmania coinfection was 9.11% (44/483). HIV mono-infected and HIV-Leishmania coinfected groups differed statistically significantly in terms of race (p = 0.045), marital status (p = 0.030), and HIV viral load (p = 0.046). Black/pardo patients, married patients, and those with an HIV viral load up to 100,000 copies/ml presented higher odds for HIV-Leishmania coinfection.

Conclusions: A considerable number of asymptomatic Leishmania cases were observed among HIV-positive individuals in a VL-endemic area. Given the potential impact on transmission and health costs, as well as the impact on these coinfected individuals, studies of asymptomatic Leishmania carriers can be useful for guiding public health policies in VL-endemic areas aiming to control and eliminate the disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Agglutination Tests
  • Anti-Retroviral Agents / therapeutic use
  • Asymptomatic Infections / epidemiology*
  • Brazil / epidemiology
  • Cross-Sectional Studies
  • Enzyme-Linked Immunosorbent Assay
  • HIV
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • Humans
  • Leishmania
  • Leishmaniasis / epidemiology*
  • Leishmaniasis, Visceral / drug therapy*
  • Leishmaniasis, Visceral / epidemiology*
  • Outpatients

Substances

  • Anti-Retroviral Agents

Grants and funding

DLG and WLBJ were supported with scholarship by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (https://www.capes.gov.br/) – Finance Code 001; AVBV and ZMM were supported by Fundação de Amparo à Ciência e Tecnologia do Estado de Pernambuco (http://www.facepe.br/), grant number APQ 1712-4.01/15; ZMD was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (http://cnpq.br/), grant number 400729/2019-9. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.