Avaliação da co-infecção por Leishmania em pessoas vivendo com HIV/aids acompanhadas no Hospital Universitário de Brasília: estudo transversal com ênfase na leishmaniose visceral

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

In order to estimate the magnitude of Leishmania/HIV co-infection, it was conducted a transversal study in people living with HIV/AIDS assisted at the outpatient Infectious and Parasitic Diseases Clinic of the Brasilia University Hospital. One hundred sixty-three patients were enrolled, seven of whom presented the clinical syndrome suggestive of visceral leishmaniasis and 156 were asymptomatic. After acceptance and signature of the informed consent, patients were submitted to a structured interview, clinical examination and collection of venous peripheral blood to detect the infection by Leishmania spp. Patients with suspicion of visceral leishmaniasis were submitted to bone marrow aspiration. The collected blood was evaluated by means of Indirect immunofluorescence test (IFAT), ELISA using soluble antigen of Leishmania chagasi (ELISA), ELISA with rK39 antigen (rK39) and polimerase chain reaction (PCR) targeted to a k-DNA conserved region of 120 bp. Bone marrow aspirate was submitted to direct examination in smears stained by Giemsa, culture for Leishmania and PCR. Twenty-six patients (16%) had positive serologic tests. The positivity was 2.4% by IFAT; 12.3% by ELISA; and 4,9% by rK39. PCR in blood was positive in three patients (1.8%). None of the symptomatic patients had positive results in bone marrow. The exploration of probable factors associated with the positivity of the applied tests did not revealed associations with: gender, previous exposition to visceral leishmaniasis endemic area, history of relatives or neighbors with visceral leishmaniasis, neither history of intravenous drug abuse. Significant statistical association was observed among positive tests and younger age (33 vs 39 years old; p=0,005); positive serologic test for Chagas disease (p=0,029); non-AIDS disease stage (p=0,004); non-use of antiretroviral therapy (p<0,001); and the presence of an infectious intercurrence at the moment of blood collection. The study demonstrated the importance of Leishmania/HIV co-infection in the assessed sample, in a region that was not considered as endemic area for visceral leishmaniasis until 2005, and only sporadic cases of cutaneous leishmaniasis in the last decades. The ELISA performed with soluble antigen of L.chagasi seems to be the method with the greater potential for the sensitive screening in order to detect Leishmania/HIV co-infected individuals. However, the specificity could be jeopardized in patients co-infected with Trypanosoma cruzi and other diseases caused by mycobacteria. The complexity and low positivity of PCR in the asymptomatic cases of Leishmania/HIV co-infection limit its use as screening of this condition.

ASSUNTO(S)

leishmaniose visceral; hiv; co-infecção-leishmania-hiv doencas infecciosas e parasitarias

ACESSO AO ARTIGO

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