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Visceral leishmaniasis in HIV-1 -infected individuals: a common opportunistic infection in Spain?.

Medrano, Francisco J.; Hernández-Quero, José; Jiménez, Enrique; Pineda, Juan A.; Rivero, Antonio; Sánchez-Quijano, Armando; Velez, Ivan D.; Viciana, Pompeyo; Castillo, Rafael; Reyes, María J.; Carvajal, Francisco; Leal, Manuel; Lissen, Eduardo

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Abstract

Objective: To investigate the epidemiological, clinical and biological features of visceral leishmaniasis (VL) in patients with HIV-1 infection.

Design: Retrospective study.

Setting: Three university hospitals in southern Spain.

Patients: Forty-seven adult patients with VL and HIV-1 infection diagnosed between January 1986 and November 1991.

Results: Forty-five out of the 47 (96%) cases were diagnosed in the last 2 years. Fever (87%), hepatomegaly (74%), splenomegaly (72%) and pancytopenia (77%) were the most common presenting features. Most patients (79%) were strongly immunocompromised when VL was diagnosed, and were in stage IV of the Centers for Disease Control classification; 87% had a CD4 lymphocyte count < 200 x 106/l. However, VL was the first severe infection diagnosed in 10 cases. Significant titres (> 1:40) of antileishmanial antibodies were detected by indirect immunofluorescence in five out of 16 (31%) cases only. Clinical response to the therapy was difficult to assess. Microbiological response was achieved in only 38% of the patients evaluated.

Conclusions: Leishmaniasis is a relatively common infection in HIV-1-infected individuals in southern Spain. Its clinical picture is quite uniform and it can be the first opportunistic infection in individuals with HIV-1. In endemic areas, a high index of clinical suspicion should be maintained in order to avoid underdiagnosis of leishmaniasis.

(C) Lippincott-Raven Publishers.

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