Singh Sarman
Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
Int J Infect Dis. 2014 Dec;29:103-12. doi: 10.1016/j.ijid.2014.07.011. Epub 2014 Oct 22.
Following the HIV epidemic, several countries have reported co-infections of Leishmania with HIV. Co-infection with these two pathogens results in rapid disease progression, more severe disease, and a poor response to treatment. A systematic review of the literature from India is presented herein. Since the first case of visceral leishmaniasis (VL) and HIV was published from India in 1999, a number of cases of HIV-Leishmania co-infection have been reported, but the proportion has been low (0.029-0.4%), as also reported in other countries where these two diseases are co-endemic. More than 89 cases of VL-HIV and 10 cases of cutaneous leishmaniasis (CL)-HIV have been published since 1999. Of these latter 10 cases, five had simple CL and five cases manifested with diffuse cutaneous leishmaniasis (DCL). In addition, one case of post-kala-azar mucocutaneous leishmaniasis in a patient with full-blown AIDS has also been reported. In two cases, it could not be ascertained whether they were cases of DCL or post-kala-azar dermal leishmaniasis from the description. Although the first case of VL-HIV co-infection was reported from the sub-Himalayan state of Uttarakhand, most cases have been reported from the VL endemic state of Bihar. HIV-Leishmania is not alarmingly high in India. Most cases were found to have occurred during 1997-2007. After that, the number of new cases decreased. This is most probably due to the low prevalence of HIV in VL and CL endemic regions and to the free supply of highly active antiretroviral therapy for HIV-infected patients.
继艾滋病流行之后，多个国家报告了利什曼原虫与艾滋病毒的合并感染情况。这两种病原体的合并感染会导致疾病快速进展、病情更加严重且治疗反应不佳。本文对来自印度的文献进行了系统综述。自1999年印度发表首例内脏利什曼病（VL）与艾滋病毒合并感染病例以来，已报告了多例艾滋病毒与利什曼原虫合并感染病例，但所占比例较低（0.029% - 0.4%），其他这两种疾病共流行的国家也有类似报告。自1999年以来，已发表了89例以上的VL - 艾滋病毒合并感染病例以及10例皮肤利什曼病（CL） - 艾滋病毒合并感染病例。在这10例后者病例中，5例为单纯CL，5例表现为弥漫性皮肤利什曼病（DCL）。此外，还报告了1例艾滋病晚期患者发生的黑热病后黏膜皮肤利什曼病病例。有2例从描述中无法确定是DCL病例还是黑热病后皮肤利什曼病病例。尽管首例VL - 艾滋病毒合并感染病例报告自喜马拉雅山脚下的北阿坎德邦，但大多数病例报告自VL流行的比哈尔邦。艾滋病毒与利什曼原虫合并感染在印度并非高得惊人。大多数病例发现于1997 - 2007年期间。此后，新发病例数量减少。这很可能是由于VL和CL流行地区艾滋病毒患病率较低以及为艾滋病毒感染患者免费提供高效抗逆转录病毒疗法所致。
