Visceral leishmaniosis in HIV-positive patients: primary infection, reactivation and latent infection. Impact of the CD4+ T-lymphocyte counts.
AIDS
; 12(16): 2147-53, 1998 Nov 12.
Article
in En
| MEDLINE
| ID: mdl-9833855
ABSTRACT
OBJECTIVE:
To discriminate cases of visceral leishmaniosis (VL) following a primary infection from cases originating in a reactivation of a latent Leishmania infection and to assess the impact of CD4+ T-cell counts on the occurrence of VL in patients with HIV disease.METHODS:
We searched by Western blotting for the presence of Leishmania infantum-specific antibodies in the sera of 236 HIV-positive patients. We performed a follow-up of antileishmanial serology and analysed the evolution of the CD4+ T-cell counts for 14 HIV-positive VL patients and for 18 HIV-positive Leishmania-seropositive patients without VL.RESULTS:
This study (1) showed that the VL disease/Leishmania infection ratio in HIV-positive individuals is high (1 10); (2) discriminated between a primary Leishmania infection (five patients who converted from Leishmania-seronegative to Leishmania-seropositive) and a reactivation of a latent infection (seven patients); (3) showed that HIV-positive individuals with dramatically low CD4+ T-cell counts maintained or generated a specific antileishmanial antibody production; (4) demonstrated that the primary-VL appeared at significantly higher (P = 0.028) CD4+ T-cell levels than the reactivation-VL; (5) documented the existence of HIV-positive Leishmania-seropositive individuals who despite a severe and prolonged immunosuppression did not develop VL (eight of 18).CONCLUSION:
Our data stress the utility of the follow-up by Western blotting for an early diagnosis of VL, and therefore an early treatment, for HIV-positive patients living in endemic areas. They suggest that in a latent Leishmania infection supplementary control mechanism(s) might operate in addition to the T-cell-mediated response, and provide a further example of non-appearance of an opportunistic infection despite a severe reduction in CD4+ T cells.
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Collection:
01-internacional
Health context:
2_ODS3
/
3_ND
Database:
MEDLINE
Main subject:
HIV Infections
/
AIDS-Related Opportunistic Infections
/
Leishmaniasis, Visceral
Type of study:
Observational_studies
/
Prognostic_studies
/
Screening_studies
Limits:
Adult
/
Animals
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
AIDS
Year:
1998
Document type:
Article