Changing spectrum of clinical presentation in visceral leishmania in HIV+ patients: preliminary results from a clinical registry in Northern Italy

Purpose: Visceral leishmania (VL) and HIV were related since the beginning of AIDS era but the impact of HAART has completely changed the pattern. Aim of the study is to describe the current presentation of this opportunistic infection. Methods: Demographics, clinical, laboratory and therapeutic findings were recorded in patients (pts) enrolled in the Ligurian registry for VL from January 1st 2007 to December 31st 2010. From these data we obtained the HIV+ features. Statistical analysis was performed using: STATA 11.0 and SPSS software 13. Statistical significance was defined as a P value <0.05. Summary of results: A total of 65 episodes in 55 pts (36 adult) were accumulated: median age 48.7 years (yrs) in adults (37.5 months in pediatric pts). All children were immunocompetent (ICC), adults included both ICC (17) and immunosuppressed (19) (ISS) pts. HIV was the leading cause of immunosuppression (10-59%) all pts. belonged to CDC stage C and they sustained 15 cases of infection; 4 were not on HAART and 4 on a failing regimen. Mean age in HIV+ pts was 38 yrs, average CD4+ count and HIV RNA at first diagnosis were respectively 135/μl ± 101 and 6,974×10 4 cp/ml (0-2.8×10 5 ). No significant CD4 r differences at first diagnosis were present among who would not recur compared to those for whom a VL recurrence was observed. Main clinical presentations were: Fever (F) + hepatosplenomegaly 8, F + lymphoadenoathy 2, F + pancytopenia 2, thrombocytopenia 2, other 1. Detection of urinary antigen and serology (IFAT) were the most frequently used diagnostic tools (respectively in 14/15 and 11/15 pts). Bone marrow detection of intracellular parasites (Giemsa) was performed only in 4/15 cases. Liposomal amphotericin B was the most frequently (98.2% of cases) prescribed drug with 100% clinical cure. VL relapses (n°5) represented a crucial finding: they occurred in 3 pts and time to relapse presented a significant difference among ICC and ISS; CD4+ cell numbers at VL recurrence were not different compared to those for the pts at baseline. Three deaths were reported, accounting for significant (15.8%) mortality. Conclusions: The main findings can be summarized as follows: clinical presentation among HIV pts is heterogeneous with frequent recurrence and remarkable mortality. Moreover, the use of both serology and urinary antigens detection for diagnostic purposes allows a reliable performance and could be very useful in pts not eligible for bone marrow aspiration. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Cenderello G et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18407 http://www.jiasociety.org/index.php/jias/article/view/18407 | http://dx.doi.org/10.7448/IAS.15.6.18407