Abstract

Visceral leishmaniasis (VL) relapse in a cohort of HIV- coinfected patients in Brazil

M.R. Dutra, P. Martins, L. Campos

Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, Brazil

Background: Although in Brazil VL-HIV coinfection is common, few studies had described this population, secondary prophylaxis use and relapse. This retrospective cohort assesses descriptive characteristics and relapse rate of VL in HIV- coinfected patients.
Methods: Patients (n=30) were followed up during 12 months after treatment of the primary VL episode in a public hospital in Belo Horizonte, Brazil, from 2003 through 2008. Clinical, behavioral and demographic data were collected from medical charts. VL relapse was defined as recrudescence of clinical symptoms and the presence of Leishmania amastigotes in positive direct examination during the follow-up. Cox's proportional hazard model was used for analysis.
Results: Letality rate of VL in the first episode was 30%. Among the 21 patients who completed follow-up, relapse rate was 33%. Among the patients who used VL prophylaxis (n=9), 11% relapsed, compared to 50% among those who did not use (n=12), (p-value=0.14). Most participants were male (75%), without history of IDU (97%), lived in the state capital metropolitan area (84%) and mean age was 38 years old. Most patients (83%) had an AIDS-defining condition before or at the time of primary VL episode. Mean CD4 cell count at baseline was 200 cells/mm³. Median time of HIV diagnosis was 10 months. For all the 7 patiens who relapsed, ART had been indicated after the first episode, but 6 of them where considered non-adherent and 5 had treatment failure before the VL relapse. Their mean CD4 cell count was 107 cells/mm³ , at the moment of the relapse.
Conclusions: Letality rate of VL among HIV-patients is higher compared to the general population. Although VL-HIV coinfection occurs in advanced immunodepression and usually takes a relapsing course, there is no standard recommendation of secondary prophylaxis for VL in Brazil.
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