Leishmaniose visceral no Brasil: letalidade e fatores associados à coinfecção Leishmania infantum e o vírus da imunodeficiência humana-estudo retrospectivo (2007-2018)

Abstract

Visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection are public health problems with a high incidence of cases and lethality in the world. The objective of this study was to estimate the lethality of VL in Brazil, to evaluate the factors associated with this lethality and the survival time in individuals with VL. The objective was also to evaluate the factors associated with Leishmania infantum/HIV coinfection in Brazil. There were two retrospective studies, the first with 37,583 individuals and the second with 28,265 individuals, notified and confirmed with VL in the Notifiable Diseases Information System (SINAN) between 2007 and 2018 (Brazil). Lethality was evaluated considering deaths from VL, deaths from other causes (OC) and non-deaths. Univariate and multivariate analyzes and survival analysis (Kaplan-Meier method) were performed. Most individuals with VL were young, male, brown, with low education and living in urban areas. The lethality was 10.2% considering deaths from VL and OC and 7.8% considering deaths from VL. The HIV infection rate in individuals with VL was 8.81%. Higher chances of deaths from VL and from other causes (OC) were observed in more advanced age groups, in female individuals and with a greater number of symptoms. A higher chance of death from OC was identified in individuals with HIV. A lower chance of deaths from VL and OC was observed for individuals undergoing VL therapy. The median survival time was longer for individuals with Leishmania infantum/HIV co-infection, but with a lower survival rate. Most individuals coinfected with Leishmania infantum/HIV were young, male, non-white, urban residents, with up to eight years of schooling and who were reported in SINAN as a new case. Higher chances of co-infection were observed for individuals aged from eleven to nineteen years (OR=1.74), twenty to thirty-nine years (OR=13.06) and over forty years (OR=6.96), who used N-methylglucamine antimoniate (OR=4.36), amphotericin B deoxycholate (OR=6.21) and liposomal amphotericin B (OR=1.60), who had relapse (OR=3.99), whose cases evolved to treatment abandonment (OR=2.00), and deaths from causes other than VL (OR=4.00) and transfer (OR=1.50). Lower chances of co-infection were observed in women (OR=0.80), living in rural areas (OR=0.54), who had five to six symptoms (OR=0.82). The data point to the need for attention to the timely diagnosis of VL and HIV infection and to the appropriate pharmacological treatment in this population, as well as the need to improve the follow-up of individuals co-infected with Leishmania infantum/HIV, in order to reduce relapses, transfers and treatment dropout.