Recurrent visceral leishmaniasis relapses in HIV co-infected patients are characterized by less efficient immune responses and higher parasite load

Yegnasew Takele; Tadele Mulaw; Emebet Adem; Rebecca Womersley; Myrsini Kaforou; Susanne Ursula Franssen; Michael Levin; Graham Philip Taylor; Ingrid Müller; James Anthony Cotton; Pascale Kropf

doi:10.1016/j.isci.2022.105867

Recurrent visceral leishmaniasis relapses in HIV co-infected patients are characterized by less efficient immune responses and higher parasite load

iScience. 2022 Dec 23;26(2):105867. doi: 10.1016/j.isci.2022.105867. eCollection 2023 Feb 17.

Affiliations

¹ Department of Infectious Disease, Imperial College London, London, UK.
² Leishmaniasis Research and Treatment Centre, University of Gondar, Gondar, Ethiopia.
³ Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.

Abstract

Visceral leishmaniasis (VL) and HIV co-infection (VL/HIV) has emerged as a significant public health problem in Ethiopia, with up to 30% of patients with VL co-infected with HIV. These patients suffer from recurrent VL relapses and increased mortality. Those with a previous history of VL relapses (recurrent VL/HIV) experience increased VL relapses as compared to patients with HIV presenting with their first episode of VL (primary VL/HIV). Our aim was to identify drivers that account for the higher rate of VL relapses in patients with recurrent VL/HIV (n = 28) as compared to primary VL/HIV (n = 21). Our results show that the relapse-free survival in patients with recurrent VL/HIV was shorter, that they had higher parasite load, lower weight gain, and lower recovery of all blood cell lineages. Their poorer prognosis was characterized by lower production of IFN-gamma, lower CD4⁺ T cell counts, and higher expression of programmed cell death protein 1 (PD1) on T cells.

Keywords: Immune response; Immunology; Virology.

Grants and funding

WT_/Wellcome Trust/United Kingdom