General aspects of visceral leishmaniasis with or without HIV co-infection in Northeast Brazil

Ur, Silva de Lima; Vanolli, Luciano; Ec, Moraes; Js, Ithamar; eCdMPe, Silva de Azevedo

doi:10.1101/403683

Cited by 2 publications

(2 citation statements)

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“…The geographic overlap of HIV-1 and L. infantum infections raises the possibility of co-infection, which several groups have shown to increase morbidity and mortality (Coura-Vital et al, 2014;Lima et al, 2017Lima et al, , 2018Viana et al, 2017;Diniz et al, 2018;Fontoura et al, 2018;Luz et al, 2018;Rezaei et al, 2018;Sousa et al, 2018;Botana et al, 2019;Diro et al, 2019;Horrillo et al, 2019;Maia-Elkhoury et al, 2019;Prestes-Carneiro et al, 2019;Santos et al, 2019;Silva de Lima et al, 2019;van Griensven et al, 2019). Several groups have studied the extent of this overlap in several Brazilian regions.…”

Section: Discussionmentioning

confidence: 99%

“…A wealth of studies worldwide (Oryan and Akbari, 2016;Grande et al, 2017;Zacarias et al, 2017;Bruhn et al, 2018;Guedes et al, 2018;Luz et al, 2018) and a recent systematic review (Fontoura et al, 2018) have demonstrated a high frequency of relapse of VL in PWH, as well as increased mortality. Relapse of VL has been reported after anti-leishmaniasis treatment, even years after the patient was considered clinically cured, especially in PWH and/or immunosuppressive conditions (Horrillo et al, 2019;Silva de Lima et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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High seroprevalence of Leishmania infantum is linked to immune activation in people with HIV: a two-stage cross-sectional study in Bahia, Brazil

et al. 2023

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Visceral leishmaniasis is an opportunistic disease in HIV-1 infected individuals, unrecognized as a determining factor for AIDS diagnosis. The growing geographical overlap of HIV-1 and Leishmania infections is an emerging challenge worldwide, as co-infection increases morbidity and mortality for both infections. Here, we determined the prevalence of people living with HIV (PWH) with a previous or ongoing infection by Leishmania infantum and investigated the virological and immunological factors associated with co-infection. We adopted a two-stage cross-sectional cohort (CSC) design (CSC-I, n = 5,346 and CSC-II, n = 317) of treatment-naïve HIV-1-infected individuals in Bahia, Brazil. In CSC-I, samples collected between 1998 and 2013 were used for serological screening for leishmaniasis by an in-house Enzyme-Linked Immunosorbent Assay (ELISA) with SLA (Soluble Leishmania infantum Antigen), resulting in a prevalence of previous or ongoing infection of 16.27%. Next, 317 PWH were prospectively recruited from July 2014 to December 2015 with the collection of sociodemographic and clinical data. Serological validation by two different immunoassays confirmed a prevalence of 15.46 and 8.20% by anti-SLA, and anti-HSP70 serology, respectively, whereas 4.73% were double-positive (DP). Stratification of these 317 individuals in DP and double-negative (DN) revealed a significant reduction of CD4+ counts and CD4+/CD8+ ratios and a tendency of increased viral load in the DP group, as compared to DN. No statistical differences in HIV-1 subtype distribution were observed between the two groups. However, we found a significant increase of CXCL10 (p = 0.0076) and a tendency of increased CXCL9 (p = 0.061) in individuals with DP serology, demonstrating intensified immune activation in this group. These findings were corroborated at the transcriptome level in independent Leishmania- and HIV-1-infected cohorts (Swiss HIV Cohort and Piaui Northeast Brazil Cohort), indicating that CXCL10 transcripts are shared by the IFN-dominated immune activation gene signatures of both pathogens and positively correlated to viral load in untreated PWH. This study demonstrated a high prevalence of PWH with L. infantum seropositivity in Bahia, Brazil, linked to IFN-mediated immune activation and a significant decrease in CD4+ levels. Our results highlight the urgent need to increase awareness and define public health strategies for the management and prevention of HIV-1 and L. infantum co-infection.

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