巴西伯南布哥州接受抗逆转录病毒治疗的 HIV 阳性门诊患者中的无症状利什曼病感染。
Asymptomatic Leishmania infection in HIV-positive outpatients on antiretroviral therapy in Pernambuco, Brazil.
机构信息
Curso de Medicina, Núcleo de Ciências da Vida, Centro Acadêmico do Agreste, Universidade Federal de Pernambuco, Caruaru, Brasil.
Departamento de Parasitologia, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil.
出版信息
PLoS Negl Trop Dis. 2021 Jan 21;15(1):e0009067. doi: 10.1371/journal.pntd.0009067. eCollection 2021 Jan.
BACKGROUND
Visceral leishmaniasis (VL) in HIV-positive individuals is a global health problem. HIV-Leishmania coinfection worsens prognosis and mortality risk, and HIV-Leishmania coinfected individuals are more susceptible to VL relapses. Early initiation of antiretroviral therapy can protect against Leishmania infection in individuals living in VL-endemic areas, and regular use of antiretrovirals might prevent VL relapses in these individuals. We conducted a cross-sectional study in Petrolina, Brazil, an VL-endemic area, to estimate the prevalence of asymptomatic Leishmania cases among HIV-positive outpatients.
METHODS
We invited any HIV-positive patients, aged ≥ 18-years-old, under antiretroviral therapy, and who were asymptomatic for VL. Patients were tested for Leishmania with enzyme-linked immunosorbent assays (ELISA)-rK39, immunochromatographic test (ICT)-rK39, direct agglutination test (DAT), latex agglutination test (KAtex), and conventional polymerase chain reaction (PCR). HIV-Leishmania coinfection was diagnosed when at least one VL test was positive.
RESULTS
A total of 483 patients were included. The sample was predominantly composed of single, < 48-years-old, black/pardo, heterosexual males, with fewer than 8 years of schooling. The prevalence of asymptomatic HIV-Leishmania coinfection was 9.11% (44/483). HIV mono-infected and HIV-Leishmania coinfected groups differed statistically significantly in terms of race (p = 0.045), marital status (p = 0.030), and HIV viral load (p = 0.046). Black/pardo patients, married patients, and those with an HIV viral load up to 100,000 copies/ml presented higher odds for HIV-Leishmania coinfection.
CONCLUSIONS
A considerable number of asymptomatic Leishmania cases were observed among HIV-positive individuals in a VL-endemic area. Given the potential impact on transmission and health costs, as well as the impact on these coinfected individuals, studies of asymptomatic Leishmania carriers can be useful for guiding public health policies in VL-endemic areas aiming to control and eliminate the disease.
背景
内脏利什曼病（VL）合并 HIV 阳性是一个全球性的健康问题。HIV-利什曼原虫共感染会恶化预后和死亡风险，且 HIV-利什曼原虫共感染的个体更容易出现 VL 复发。在 VL 流行地区，早期启动抗逆转录病毒治疗可以预防利什曼原虫感染，而定期使用抗逆转录病毒药物可能会预防这些个体的 VL 复发。我们在巴西的一个 VL 流行地区佩特罗利纳进行了一项横断面研究，以估计 HIV 阳性门诊患者中无症状利什曼病例的患病率。
方法
我们邀请了所有接受抗逆转录病毒治疗、年龄≥ 18 岁且无症状 VL 的 HIV 阳性患者。患者接受了酶联免疫吸附试验（ELISA）-rK39、免疫层析试验（ICT）-rK39、直接凝集试验（DAT）、乳胶凝集试验（KAtex）和常规聚合酶链反应（PCR）检测利什曼原虫。至少一项 VL 检测阳性时诊断为 HIV-利什曼原虫共感染。
结果
共纳入 483 例患者。该样本主要由单例、< 48 岁、黑/棕肤色、异性恋男性组成，受教育程度< 8 年。无症状 HIV-利什曼原虫共感染的患病率为 9.11%（44/483）。HIV 单一感染组和 HIV-利什曼原虫共感染组在种族（p=0.045）、婚姻状况（p=0.030）和 HIV 病毒载量（p=0.046）方面有统计学差异。黑/棕肤色患者、已婚患者和 HIV 病毒载量< 100000 拷贝/ml 的患者更有可能发生 HIV-利什曼原虫共感染。
结论
在 VL 流行地区，HIV 阳性个体中观察到相当数量的无症状利什曼病例。鉴于其对传播和卫生保健费用的潜在影响，以及对这些共感染个体的影响，对无症状利什曼携带者的研究有助于指导 VL 流行地区的公共卫生政策，以控制和消除该疾病。
Zotero 插件