Leishmaniasis–HIV coinfection: current challenges

Abstract

José Angelo Lauletta Lindoso,1,2 Mirella Alves Cunha,3 Igor Thiago Queiroz,4 Carlos Henrique Valente Moreira2 1Laboratory of Soroepidemiology (LIM HC-FMUSP), São Paulo University, São Paulo, 2Instituto de Infectologia Emilio Ribas-SES, São Paulo, 3Department of Infectious Disease, Faculty of Medicine, São Paulo University, São Paulo, 4Hospital Giselda Trigueiro - SESAP, Natal, Brazil Abstract: Leishmaniasis – human immunodeficiency virus (HIV) coinfection can manifest itself as tegumentary or visceral leishmaniasis. Almost 35 countries have reported autochthonous coinfections. Visceral leishmaniasis is more frequently described. However, usual and unusual manifestations of tegumentary leishmaniasis have been reported mainly in the Americas, but the real prevalence of Leishmania infection in HIV-infected patients is not clear. Regarding the clinical manifestations, there are some reports showing unusual manifestations in visceral leishmaniasis and tegumentary leishmaniasis in HIV-infected patients; yet, the usual manifestations are more frequent. Leishmaniasis diagnosis relies on clinical methods, but serological tests are used to diagnose visceral leishmaniasis despite them having a low sensitivity to tegumentary leishmaniasis. The search for the parasite is used to diagnose both visceral leishmaniasis and tegumentary leishmaniasis. Nevertheless, in HIV-infected patients, the sensitivity of serology is very low. Drugs available to treat leishmaniasis are more restricted and cause severe side effects. Furthermore, in HIV-infected patients, these side effects are more prominent and relapses and lethality are more recurrent. In this article, we discuss the current challenges of tegumentary leishmaniasis and visceral leishmaniasis–HIV infection, focusing mainly on the clinical manifestations, diagnosis, and treatment of leishmaniasis. Keywords: leishmaniasis, HIV infection, coinfection, epidemiology, clinical manifestations, diagnosis, treatment 

Keywords

• Leishmaniasis
• HIV-infection
• coinfection
• epidemiology
• clinical manifestations
• diagnosis
• treatment.