Visceral Leishmaniasis-HIV Coinfection as a Predictor of Increased Leishmania Transmission at the Village Level in Bihar, India

Abstract

BackgroundVisceral leishmaniasis (VL) is on the verge of being eliminated as a public health problem in the Indian subcontinent. Although Post-kala-azar dermal leishmaniasis (PKDL) is recognized as an important reservoir of transmission, we hypothesized that VL patients co-infected with Human Immunodeficiency Virus (HIV) may also be important reservoirs of sustained leishmania transmission. We therefore investigated to what extent cases of PKDL or VL-HIV are associated with VL incidence at the village level in Bihar, India.MethodsVL, VL-HIV, and PKDL case data from six districts within the highly VL-endemic state of Bihar, India were collected through the Kala-Azar Management Information System for the years 2014–2019. Multivariate analysis was done using negative binomial regression controlling for year as a fixed effect and block (subdistrict) as a random effect.FindingsPresence of VL-HIV+ and PKDL cases were both associated with a more than twofold increase in VL incidence at village level, with Incidence Rate Ratios (IRR) of 2.16 (95% CI 1.81–2.58) and 2.37 (95% CI 2.01–2.81) for VL-HIV+ and PKDL cases respectively. A sensitivity analysis showed the strength of the association to be similar in each of the six included subdistricts.ConclusionsThese findings indicate the importance of VL-HIV+ patients as infectious reservoirs for Leishmania, and suggest that they represent a threat equivalent to PKDL patients towards the VL elimination initiative on the Indian subcontinent, therefore warranting a similar focus.

Prevalence and determinants of asymptomatic Leishmania infection in HIV-infected individuals living within visceral leishmaniasis endemic areas of Bihar, India

“…As the effort to eliminate VL as a public health problem has progressed substantially in the ISC, the proportion of patients with VL-HIV has increased both in absolute numbers and as a proportion of all VL cases. Indeed, a more recent analysis of the epidemiological spread and impact of VL-HIV has suggested that the presence of VL-HIV cases was associated with a greater than two-fold increase in VL incidence at the village level, with an incidence risk ratio similar to that of post kala-azar dermal leishmaniasis (PKDL) [ 13 ]. As such, establishing the scale of asymptomatic infections in HIV patients may contribute significantly to improved programmatic policy in sustaining elimination targets.…”

Host–Pathogen Interaction in Leishmaniasis: Immune Response and Vaccination Strategies

“…Environmental factors such as climate change involving alterations in temperature, deforestation, natural disasters and poor socio-economic factors, also contribute to the spread of this disease. Due to geographical overlap, malaria-VL co-infections occur in large populations; it is common in East African countries where malaria and VL are co-endemic [17,18]. Drug resistance, organ transplantation and immunosuppression by HIV-1 contribute to the spread of Leishmaniasis [19].…”

Hematological and Clinical Features Associated with Initial Poor Treatment Outcomes in Visceral Leishmaniasis Patients with and without HIV Coinfection in Gondar, Northwest Ethiopia

“…Anti-leishmanial drugs also showed high toxicity in HIV coinfected VL cases [ 17 , 21 ]. Overall, Leishmania –HIV coinfection poses challenges to the VL control effort [ 3 , 22 , 23 ]. Despite efforts made to identify a new combination of treatments to control the disease, VL with and without HIV coinfection continues to pose a challenge.…”