Visceral leishmaniasis and HIV-1 co-infection in southern France

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 89; no. 2; pp. 159 - 162
• Main Authors: Rosenthal, Eric, Marty, Pierre, Poizot-Martin, Isabelle, Reynes, Jacques, Pratlong, Francine, Lafeuillade, Alain, Jaubert, Dominique, Boulat, Olivier, Dereure, Jacques, Gambarelli, Françoise, Gastaut, Jean-Albert, Dujardin, Pierre, Dellamonica, Pierre, Cassuto, Jill-Patrice
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford Elsevier Ltd 01.03.1995; Royal Society of Tropical Medicine and Hygiene; Elsevier
• Subjects: Adult; Aged; AIDS-Related Opportunistic Infections - complications; AIDS-Related Opportunistic Infections - epidemiology; AIDS/HIV; Amphotericin B - therapeutic use; Antibodies, Protozoan - analysis; Antimony Sodium Gluconate - therapeutic use; Biological and medical sciences; co-infection; Female; France; France - epidemiology; HIV-1; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Leishmania infantum; Leishmaniasis, Visceral - complications; Leishmaniasis, Visceral - drug therapy; Leishmaniasis, Visceral - epidemiology; Male; Medical sciences; Middle Aged; Retrospective Studies; Treatment Outcome; Tropical medicine; visceral leishmaniasis; France; Europe; HIV-1; Leishmania infantum; co-infection; France; visceral leishmaniasis; Human; Immunopathology; Protozoa; Protozoal disease; Seropositivity; HIV-1 virus; Retroviridae; Kala azar; AIDS; Leishmaniasis; Parasitosis; Immune deficiency; Infection; Virus; Association; Viral disease; Rhizoflagellata; Lentivirinae; Human immunodeficiency virus
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/0035-9203(95)90476-X

Between 1986 and 1993 visceral leishmaniasis (VL) was diagnosed in 50 adult patients with human immunodeficiency virus type 1 (HIV-1) infection (8 females, 42 males: 31 intravenous drug users, 11 homosexual or bisexual men, 6 heterosexual individuals, 2 blood recipients) from 5 hospital centres in southern France. Diagnosis of VL was by demonstration of Leishmania and isolation of promastigotes by culture in Novy-McNeal-Nicolle medium. Leishmania isolates were identified by their isoenzyme profile in 28 patients. All the patients were immunocompromised when VL was diagnosed. Their median CD4 cell count was 25 × 10 6 (0–200). However, only 21 patients (42%) fulfilled the 1987 CDC criteria for the acquired immune deficiency syndrome before VL developed. Fever (84%), splenomegaly (56%), hepatomegaly (34%), and pancytopenia (62%) were the most common presenting features. Clinical signs were lacking in 10% of patients. Anti-leishmanial antibodies were detected by indirect immunofluorescence or enzyme-linked immunosorbent assay in 26 47 cases (55%). Combining these techniques with Western blotting (WB) gave a positivity rate of 95%. Amastigotes were demonstrated in bone marrow aspirates in 47 cases (94%). Unusual sites for parasites were found in 17 patients (34%), mainly in the digestive tract but also skin and lung. Viscerotropic L. infantum zymodeme MON-1 was characterized in 86% of cases. Dermotropic zymodemes MON-24, MON-29, MON-33, and a previously undescribed zymodeme MON-183, were isolated from 4 patients. The response rate to pentavalent antimony was 50% and to amphotericin B 100%, but clinical relapses were noted in both groups. In endemic areas, VL should be considered as a possible opportunistic infection in HIV-infected patients. WB would be a valuable tool for diagnosis of VL in these patients.