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Journal of Clinical Microbiology, September 1998, p. 2419-2422, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Prevalence of and Factors Associated with Visceral Leishmaniasis in Human Immunodeficiency Virus Type 1-Infected Patients in Southern Spain

Juan A. Pineda,1,* José A. Gallardo,1 Juan Macías,1 Juan Delgado,1 Carmen Regordán,2 Francisco Morillas,3 Federico Relimpio,1 Joaquina Martín-Sánchez,3 Armando Sánchez-Quijano,1 Manuel Leal,1 and Eduardo Lissen1

Viral Hepatitis and AIDS Study Group1 and Department of Microbiology,2 Hospital Universitario Virgen del Rocío, 41013-Seville, and Department of Parasitology, Facultad de Farmacia, Universidad de Granada, 18071-Granada,3 Spain

Received 3 March 1998/Returned for modification 20 April 1998/Accepted 8 June 1998

The actual prevalence of visceral leishmaniasis among human immunodeficiency type 1 (HIV-1)-infected patients in the Mediterranean basin remains unknown. There is also controversy about the risk factors for Leishmania infantum and HIV-1 coinfection. To appraise the prevalence of visceral leishmaniasis in patients infected with HIV-1 in southern Spain and to identify factors associated with this disease, 291 HIV-1 carriers underwent a bone marrow aspiration, regardless of their symptoms. Giemsa-stained samples were searched for Leishmania amastigotes. Thirty-two (11%) patients showed visceral leishmaniasis. Thirteen (41%) patients had subclinical cases of infection. Centers for Disease Control and Prevention (CDC) clinical category C was the factor most strongly associated with this disease (adjusted odds ratio [OR], 1.88 [95% confidence interval, 1.22 to 2.88]), but patients with subclinical cases of infection were found in all CDC categories. Female sex was negatively associated with visceral leishmaniasis (adjusted OR, 0.42 [95% confidence interval, 0.18 to 0.97]). Intravenous drug users showed a higher prevalence than the remaining patients (13.3 versus 4.9%; P = 0.04), but such an association was not independent. These results show that visceral leishmaniasis is a very prevalent disease among HIV-1-infected patients in southern Spain, with a high proportion of cases being subclinical. Like other opportunistic infections, subclinical visceral leishmaniasis can be found at any stage of HIV-1 infection, but symptomatic cases of infection appear mainly when a deep immunosuppression is present. There is also an association of this disease with male sex and intravenous drug use.

* Corresponding author. Mailing address: Viral Hepatitis and AIDS Study Group, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013-Sevilla, Spain. Phone: 34-5-4248154. Fax: 34-5-4248249. E-mail: vergara{at}cica.es.

Journal of Clinical Microbiology, September 1998, p. 2419-2422, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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