This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by de la Rosa, R.
Right arrow Articles by Lissen, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by de la Rosa, R.
Right arrow Articles by Lissen, E.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, March 2002, p. 762-767, Vol. 40, No. 3
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.3.762-767.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Incidence of and Risk Factors for Symptomatic Visceral Leishmaniasis among Human Immunodeficiency Virus Type 1-Infected Patients from Spain in the Era of Highly Active Antiretroviral Therapy

Rafael de la Rosa,1 Juan A Pineda,2* Juan Delgado,1 Juan Macías,2 Francisco Morillas,3 José A. Mira,2 Armando Sánchez-Quijano,1 Manuel Leal,1 and Eduardo Lissen1

Viral Hepatitis and AIDS Study Group, Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío ,1 Servicio de Medicina Interna, Hospital Universitario de Valme, Seville,2 Departamento de Parasitologia, Facultad de Farmacia, Universidad de Granada, Granada, Spain3

Received 23 March 2001/ Returned for modification 14 August 2001/ Accepted 1 December 2001

The way in which the extensive use of highly active antiretroviral therapy (HAART) has influenced the incidence of visceral leishmaniasis (VL) among human immunodeficiency type 1 (HIV-1)-infected patients is not yet understood. The present study assessed whether the incidence of symptomatic VL in HIV-infected patients has decreased since the introduction of HAART. Likewise, the role of other potential risk factors for VL was also analyzed. Therefore, 479 HIV-1-infected patients receiving antiretroviral treatment, according to the available drugs at each moment, were prospectively followed from April 1989 to June 2000 in two university hospitals in southern Spain. A bone marrow aspiration was performed when patients showed symptoms suggestive of kala-azar. A diagnosis of VL was made when Leishmania amastigotes were seen in Giemsa-stained samples or promastigotes were cultured in specific media. The median follow-up time was 1,380 [8 to 4,536] days. Twenty-one patients were diagnosed with symptomatic VL. The density of incidence of VL has decreased 64.8% as of January 1997, when HAART began to be used extensively in our area. The use of HAART was the main independent factor associated with VL; this therapy was a protective factor (adjusted hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.02 to 0.15). CDC clinical category C at entry in the cohort (HR, 4.08; 95% CI, 1.46 to 11.35) and CD4+ cell counts below 300 cells/mm3 during the follow-up (HR, 3.96; 95% CI, 1.56 to 10.01) were also independently associated with kala-azar. A VL diagnosis prior to follow-up and low compliance with antiretroviral therapy were not independently associated with symptomatic VL, although statistical significance was almost reached (P = 0.1 and P = 0.08, respectively). In summary, the use of HAART has led to a fall in the incidence of symptomatic VL in HIV-infected patients. The main risk factor associated with kala-azar emergence in patients infected with HIV is deep immunosuppression.

* Corresponding author. Mailing address: Hospital Universitario de Valme. Servicio de Medicina Interna. Carretera de Cádiz s/n. 41014 Seville, Spain. Phone and fax: 34-95-5015777. E-mail: japineda{at}nacom.es.

Journal of Clinical Microbiology, March 2002, p. 762-767, Vol. 40, No. 3
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.3.762-767.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Alvar, J., Aparicio, P., Aseffa, A., Den Boer, M., Canavate, C., Dedet, J.-P., Gradoni, L., Ter Horst, R., Lopez-Velez, R., Moreno, J. (2008). The Relationship between Leishmaniasis and AIDS: the Second 10 Years. Clin. Microbiol. Rev. 21: 334-359 [Abstract] [Full Text]  
  • Molina, I., Falco, V., Crespo, M., Riera, C., Ribera, E., Curran, A., Carrio, J., Diaz, M., Villar del Saz, S., Fisa, R., Lopez-Chejade, P., Ocana, I., Pahissa, A. (2007). Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients. J Antimicrob Chemother 60: 837-842 [Abstract] [Full Text]  
  • MARTIN-SANCHEZ, J., PINEDA, J. A., MORILLAS-MARQUEZ, F., GARCIA-GARCIA, J. A., ACEDO, C., MACIAS, J. (2004). DETECTION OF LEISHMANIA INFANTUM KINETOPLAST DNA IN PERIPHERAL BLOOD FROM ASYMPTOMATIC INDIVIDUALS AT RISK FOR PARENTERALLY TRANSMITTED INFECTIONS: RELATIONSHIP BETWEEN POLYMERASE CHAIN REACTION RESULTS AND OTHER LEISHMANIA INFECTION MARKERS. Am J Trop Med Hyg 70: 545-548 [Abstract] [Full Text]  
  • MIRA, J. A., CORZO, J. E., RIVERO, A., MACIAS, J., DE LEON, F. L., TORRE-CISNEROS, J., GOMEZ-MATEOS, J., JURADO, R., PINEDA, J. A. (2004). FREQUENCY OF VISCERAL LEISHMANIASIS RELAPSES IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY. Am J Trop Med Hyg 70: 298-301 [Abstract] [Full Text]  
  • Davies, C. R, Kaye, P., Croft, S. L, Sundar, S. (2003). Leishmaniasis: new approaches to disease control. BMJ 326: 377-382 [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»