Leishmaniases and HIV/AIDS co-infections: review of common features and management experiences

The visceral and the different spectrum of cutaneous leishmaniases have been incriminated to be among the opportunistic infections co-existing with HIV/AIDS. In co-infections, leishmaniases surface in high prevalence, present frequently atypically, pose difficulties to be detected by routine diagnostic tests, most often result in an unfavorable response to treatment, frequent relapses and in premature deaths. Such presentations and management difficulties shall be highlighted in this review. To extract information on the scope of manifestations and responses to management, literature was surveyed utilizing the Pub Med electronic literature search. In due course, pertinent characteristics surfacing in HIV/AIDS and leishmaniasis co-infections comprising of clinical presentations and parasitological and serological findings were tracked. Investigation options, management approaches, outcomes of various treatment regimen and other intervention strategies were as well explored. Visceral leishmaniasis and HIV-1 are both associated with a depression of T cell response and similar disturbances of cytokine networks. The appearance of HIV has led to numerous atypical clinical manifestations of leishmaniasis among immunocompromised patients to include, recurrences, lingual, cervical, esophageal, mucocutaneous and presentations in other unusual sites. The common clinical presentations of the disease might not always be present being masked by other associated opportunistic infections. Spleen aspiration is more sensitive in immuno-competent visceral visceral leishmaniasis suspects, however, bone marrow aspirate remains the safest and the most frequently employed diagnostic technique in co-infected patients. Several species of Leishmania are incriminated in affecting HIV infected subjects, including formerly unknown zymodemes. In spite of the high number of reported cases of HIV-related VL, the treatment of choice, the best dosage and the duration of therapy appear not to be properly established. The pentavalent antimonials still remain the first line of therapy for co-infected cases. Amphotericin-B, especially the liposome formulation (Ambisome) was found to be relatively less toxic and more potent compared to pentamidine. A broad spectrum of other drugs have as well been used. The widespread use of HAART are envisaged to contribute to a progressive decrease in the morbidity and mortality of HIV-associated visceral leishmaniasis. There is no effective chemoprophylaxis or immuno-prophylaxis to prevent leishmanial infection. In the events of co-infections with HIV/AIDS, the need for policy provisions to control both diseases needs to be underlined. It is as well of a paramount importance that factors influencing co-infection are understood for effective treatment against leishmaniasis in co-infected patients. The need for improved diagnostic tests and new more effective and less toxic drugs is also apparent.