[Visceral leishmaniasis in patients with HIV infection]

Visceral leishmaniasis (VL) is an endemic parasitosis in Spain with a frequency which is increasing, specially among those patients with HIV infection.

The clinical characteristics of 36 episodes of VL in 20 patients with HIV infection diagnosed in the authors' center from January 1988 to October 1993 are herein described. The appearance of recurrences and mortality rate were analyzed with survival curves.

The most frequently observed findings were constitutional syndrome (92%), fever (67%), splenomegaly (86%), hepatomegaly (80%) and hematologic changes (100%) with the symptoms being of longer duration in the initial episodes than in the recurrences. In 97% of the patients the CD4+ lymphocyte count was lower than 200 x 10(6)/l, with greater immunosuppression observed during the recurrences. Serology (IFI) was positive in 25% of the patients. Microscopic examination of bone marrow aspirate demonstrated the presence of Leishmania amastigotes in 82% of the initial episodes and in all the recurrences. Neither the bone marrow biopsy nor the culture improved this performance. Less than 10% of the episodes were recurrence free at 12 months of evolution with allopurinol prophylaxis not being useful. Mortality directly attributable to VL was nul and the survival curve showed a worse prognosis for patients who had a diagnosis of AIDS previously or simultaneously to the presentation of VL.

The clinical manifestations of visceral leishmaniasis in patients with HIV infection are similar to those presented by non immunosuppressed patients. The serology is little sensitive for diagnosis and the exploration of choice is the microscopic examination of the bone marrow aspirate. The prognosis of acute infection is good but the frequency of recurrence is high. The authors believe that visceral Leishmaniasis should be considered as a diagnostic criteria for AIDS.