Social Pharmacy Department, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
René Rachou Institute, Fiocruz Minas Gerais, Belo Horizonte, Brazil.
Parasitol Res. 2022 Feb;121(2):725-736. doi: 10.1007/s00436-022-07429-3. Epub 2022 Jan 11.
Visceral leishmaniasis (VL) is a public health problem with a high prevalence and lethality in Brazil. This study aims to estimate the lethality and associated factors in individuals with VL and assess survival time, emphasizing VL/HIV coinfection. This retrospective study has 37,583 individuals notified and confirmed with VL in the Sistema de Informação de Agravos de Notificação (SINAN) between 2007 and 2018 (Brazil). Lethality was evaluated considering VL deaths, deaths from other causes (OC), and non-deaths. We performed a multinomial logistic regression, with non-death as the benchmark category. We conducted a survival analysis (Kaplan-Meier method), emphasizing VL/HIV coinfection. Most individuals were young, male, mixed race, low schooling level, and urban dwellers. The lethality rate was 10.2% (VL and OC deaths) and 7.8% (VL deaths). The prevalence of HIV infection was 8.81%. A higher likelihood of VL and OC deaths was observed in older age groups, females, and with a higher number of symptoms. A higher likelihood of OC deaths was identified in individuals with HIV. A lower likelihood of VL and OC deaths was observed for individuals on VL therapy. The mean survival time was longer for VL/HIV individuals, who had a lower survival rate than those with VL. The data point to the need for attention to the timely diagnosis of VL and HIV and adequate pharmacological treatment in this population.
内脏利什曼病（VL）是巴西一个具有高患病率和致死率的公共卫生问题。本研究旨在评估 VL 患者的病死率及其相关因素，并评估生存时间，重点关注 VL/HIV 合并感染。本回顾性研究共纳入了 37583 名于 2007 年至 2018 年期间在巴西国家传染病监测系统（SINAN）中报告并确诊的 VL 患者。病死率评估考虑了 VL 死亡、其他原因（OC）死亡和非死亡。我们进行了多变量逻辑回归分析，以非死亡为基准类别。我们进行了生存分析（Kaplan-Meier 法），重点关注 VL/HIV 合并感染。大多数患者年龄较轻，男性，混合种族，教育水平较低，居住在城市。病死率为 10.2%（VL 和 OC 死亡）和 7.8%（VL 死亡）。HIV 感染的患病率为 8.81%。年龄较大、女性以及症状较多的患者，VL 和 OC 死亡的可能性更高。HIV 感染者发生 OC 死亡的可能性更高。接受 VL 治疗的患者，VL 和 OC 死亡的可能性较低。VL/HIV 患者的平均生存时间较长，但生存率低于仅患 VL 的患者。这些数据表明，需要关注及时诊断 VL 和 HIV，并为该人群提供适当的药物治疗。
