Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough?

BackgroundThe urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.MethodsCases of VL/HIV coinfection were obtained through a probabilistic record linkage of databases of VL and AIDS cases from the Brazilian Ministry of Health.ResultsWe retrieved 760 cases of VL/HIV coinfection, most prevalent in adult males, with incidence ranging from 0.01 to 0.07 cases, per 100.000 population, in 2001 and 2010, respectively. Case-fatality rates were 27.3% in 2001 and 23.2% in 2010. Weakness, weight loss, cough, other associated infections and haemorrhagic phenomena were more commonly found among coinfected patients, which had a fatality rate three times higher as compared to the non-coinfected group. The relapse proportion was two times greater among coinfected (6.3%) than non-coinfected (3.1%).ConclusionsThe results found herein contribute to the increase of knowledge of the epidemiological situation of VL/HIV coinfection in Brazil and reinforce the necessity of implementing specific strategies to improve early case detection and efficacious and less toxic treatment in order to achieve lower case-fatality rates.背景 巴西内脏利什曼病（visceral leishmaniasis, VL）的城市化传播趋势，以及HIV感染向农村地区的蔓延，均可能是导致利什曼原虫/HIV合并感染病例数攀升的潜在机制。本研究旨在描述VL/HIV合并感染患者的临床与流行病学特征，并将该特征与单纯感染VL的患者进行对比。 方法 本研究通过巴西卫生部的VL病例数据库与艾滋病（AIDS）病例数据库，采用概率记录链接法获取VL/HIV合并感染病例。 结果 本研究共检索到760例VL/HIV合并感染病例，患者以成年男性最为高发；2001年发病率为每10万人口0.01例，2010年升至每10万人口0.07例。2001年的病例病死率为27.3%，2010年为23.2%。合并感染患者更常出现乏力、体重下降、咳嗽、其他合并感染及出血征象，其病死率较单纯VL感染组高出3倍。合并感染患者的复发比例为6.3%，是单纯感染组（3.1%）的2倍。 结论 本研究结果有助于深化对巴西VL/HIV合并感染流行病学现状的认知，同时强调需制定针对性防控策略，以提升病例早期检出率、采用高效且低毒的治疗方案，进而降低病例病死率。