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巴西的内脏利什曼病与艾滋病毒/艾滋病:我们对此了解够多了吗?

Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough?

作者信息

Leite de Sousa-Gomes Marcia, Romero Gustavo Adolfo Sierra, Werneck Guilherme Loureiro

机构信息

Secretary of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil.

Professional Master Program in Epidemiology in Public Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil.

出版信息

PLoS Negl Trop Dis. 2017 Sep 25;11(9):e0005772. doi: 10.1371/journal.pntd.0005772. eCollection 2017 Sep.

Abstract

BACKGROUND

The urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.

METHODS

Cases of VL/HIV coinfection were obtained through a probabilistic record linkage of databases of VL and AIDS cases from the Brazilian Ministry of Health.

RESULTS

We retrieved 760 cases of VL/HIV coinfection, most prevalent in adult males, with incidence ranging from 0.01 to 0.07 cases, per 100.000 population, in 2001 and 2010, respectively. Case-fatality rates were 27.3% in 2001 and 23.2% in 2010. Weakness, weight loss, cough, other associated infections and haemorrhagic phenomena were more commonly found among coinfected patients, which had a fatality rate three times higher as compared to the non-coinfected group. The relapse proportion was two times greater among coinfected (6.3%) than non-coinfected (3.1%).

CONCLUSIONS

The results found herein contribute to the increase of knowledge of the epidemiological situation of VL/HIV coinfection in Brazil and reinforce the necessity of implementing specific strategies to improve early case detection and efficacious and less toxic treatment in order to achieve lower case-fatality rates.

摘要

背景

内脏利什曼病(VL)的城市化以及巴西艾滋病感染向农村地区的同时传播,可能是导致利什曼原虫/艾滋病毒合并感染人数增加的相关机制。本研究旨在描述VL/艾滋病毒合并感染患者的临床和流行病学特征,并将该特征与未合并感染的VL患者进行比较。

方法

通过对巴西卫生部VL和艾滋病病例数据库进行概率性记录链接,获取VL/艾滋病毒合并感染病例。

结果

我们检索到760例VL/艾滋病毒合并感染病例,最常见于成年男性,2001年和2010年的发病率分别为每10万人口0.01至0.07例。2001年的病死率为27.3%,2010年为23.2%。合并感染患者中更常出现虚弱、体重减轻、咳嗽、其他相关感染和出血现象,其病死率比未合并感染组高两倍。合并感染患者的复发率(6.3%)是非合并感染患者(3.1%)的两倍。

结论

本文的研究结果有助于增加对巴西VL/艾滋病毒合并感染流行病学情况的了解,并强化实施特定策略以改善早期病例检测以及有效且低毒治疗从而降低病死率的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/668b/5612457/d351412cb429/pntd.0005772.g001.jpg

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