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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