Rosenthal E, Marty P, Poizot-Martin I, Mondain V, Reynes J, Pratlong F, Lafeuillade A, Jaubert D, Boulat O, Dereure J; International Conference on AIDS.
Int Conf AIDS. 1994 Aug 7-12; 10: 160 (abstract no. PB0652).
Hospital Centers of Nice, France.
OBJECTIVE: To investigate the epidemiological, clinical and biological features of visceral leishmaniasis (VL) in adult patients with HIV-1 infection. PATIENTS AND METHODS: Between 1986 and 1993, VL was diagnosed in 50 adult patients with HIV-1 infection (8 female, 42 male: 31 IV drug users, 11 homo or bisexual men, 6 heterosexual individuals, 2 blood recipients). Diagnosis of VL was assessed by demonstration of Leishmania, and isolation of promastigotes by culture in NNN medium. Leishmania isolates were identified by their isoenzyme profile (zymodeme) in 28 patients. RESULTS: All the patients were immunocompromised when VL was diagnosed. Median CD4 count was 25 x 10(6)/l (0-200). In contrast, only 21 patients (42%) fullfilled the 1987 CDC defining criteria for AIDS before VL. Fever (84%), splenomegaly (56%), hepatomegaly (34%) and pancytopenia (62%) were the most common presenting features. However, clinical signs lacked in 10% of patients. Research for anti-leishmanial antibodies (IF or ELISA) was positive in 26/47 cases (55%). Combining these techniques with Western Blot (WB) gave 95% of positivity. Amastigotes were demonstrated in bone marrow aspirates in 47 cases (94%). Unusual localizations of parasites were found in 17 (34%) patients (digestive tract, skin, lung, peripheral blood leukocytes). Viscerotropic L. infantum zymodeme MON-1 was characterized in 86% of cases. Dermotropic zymodemes MON-24, -29, -33, and a previously undescribed zymodeme MON-183 were responsible for VL in 4 patients. Response rate to pentavalent antimony was 50% vs 100% for Amphotericin B, but clinical relapses were noted in the 2 groups. CONCLUSION: In endemic areas, VL should be considered as an opportunistic infection in HIV-infected patients. WB would be a valuable tool for diagnosis of VL in these patients. First-line treatment and schedules for secondary prophylaxis remain to be investigated. The increased frequency of VL-HIV co-infection in South European countries, and the existence of VL and AIDS overlapping areas, such as South America, Asia and East Africa appear as a strong potential risk for epidemic outbreaks.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Adult
- Africa
- Amphotericin B
- Antimony
- Antimony Sodium Gluconate
- Asia
- Female
- HIV Infections
- HIV Seropositivity
- HIV-1
- Humans
- Leishmania
- Leishmania donovani
- Leishmania infantum
- Leishmaniasis, Visceral
- Male
- South America
Other ID:
UI: 102210094
From Meeting Abstracts