Comparação de aspectos clínicos e diagnósticos da leishmaniose visceral entre portadores e não portadores do vírus da imunodeficiência humana

Abstract

To describe and compare demographic, clinical and diagnostic features of visceral leishmaniasis (VL) among HIV-positive or negative individuals, a retrospective study was conducted using data collected from January 2000 to December 2005 at two referral healthcare centers of Belo Horizonte: the outpatient unit at Centro de Pesquisas René Rachou, and the outpatient and inpatient units at Hospital Eduardo de Menezes. VL was diagnosed as either: i) a positive ( 1:80) serum anti-Leishmania IgG indirect immunofluorescence assay (IFA), plus any two of the following clinical manifestations: fever, anemia/citopenia, splenomegaly/hepatomegaly; or ii) detection of Leishmania genome by PCR assay, or parasites by direct staining or culture of bone marrow, liver, spleen or lymph node samples. Excluded were patients with unavailable HIV testing results or history of VL treated 72 hours before study enrollment. Overall, 65 patients met eligibility criteria. Mean age was 37,6 years-old (± 12,1) and 81,5% were male. Twenty-seven patients were HIV-infected; median CD4+ T cell count was 115 cells/mm3, and most (74%) patients had counts below 200 cells/mm3. At baseline, intravenous drug use did not significantly differ between groups, but alcohol abuse was more frequent among HIV-infected patients (p<0,05). The classical clinical triad of fever, anemia and/or citopenia, and splenomegaly and/or hepatomegaly was present at similar high frequencies in HIV-positive and negative patients (70,4% vs. 76,5%; p=0,6). As compared to non-HIV-infected individuals, HIV-infected subjects were more likely to have hyperglobulinemia, hypoalbuminemia and lymphopenia at baseline, and less likely to have elevated serum bilirubin levels. After ten to 15 days of antileishmanial treatment, fever, anemia, leucopenia and eosinopenia were significantly more frequent among HIV-infected subjects. Conversely, mean serum creatinine was significantly higher in this group. The adjusted odds of complete clinical resolution after ten to 15 days of treatment initiation was significantly lower in HIV-positive patients (odds ratio-OR= 0,04; 95%CI= 0,01-0,45), or in the presence of splenomegaly (OR= 0,06; 95%CI= 0,01-0,69) or > three clinical signs/symptoms (OR= 0,12; 95%CI= 0,02-0,74) at baseline. Leishmania parasites were identified in 74% of HIV-infected subjects and in 53% of HIV-negative individuals (p=0,08). Anti-Leishmania IgG IFAT was more sensitive among HIV-negative patients (86,4% vs. 45,5%; p<0,01). The sensitivities of the anti-rK39 ELISA assay were marginally non-different between HIV-infected or uninfected subjects (50% vs. 92,3% respectively; p= 0,052).