Frequency of Leishmania spp. infection among HIV-infected patients living in an urban area in Brazil: a cross-sectional

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RESEARCH ARTICLE

Open Access

Frequency of Leishmania spp. infection among HIV-infected patients living in an urban area in Brazil: a cross-sectional study M. A. Cunha1,2* , B. J. Celeste3, N. Kesper4, M. Fugimori3, M. M. Lago5, A. S. Ibanes5, L. M. Ouki5, E. A. Simões Neto6, F. F. Fonseca7, M. A. L. Silva8, W. L. Barbosa Júnior8 and J. A. L. Lindoso2,4,5

Abstract Background: There is little information about the frequency of Leishmania infection in asymptomatic people living with HIV (PLWH) and about the performance of laboratory diagnostic methods in coinfected patients in Latin America. The main objective of this study is to evaluate the frequency of Leishmania spp. infection in HIV-infected patients living in an urban area in Brazil. Methods: To detect Leishmania infection, diagnostic tests were performed to detect anti-Leishmania antibodies (ELISA using Leptomonas seymouri antigens; ELISA using rK39 antigens; ELISA using rK28 antigens; indirect fluorescent-antibody test (IFAT); direct agglutination test (DAT)) and Leishmania DNA (polymerase chain reaction (PCR) with the target genes kDNA and ITS-1). Results: The frequency of at least one positive test was 15%. For ELISA using Leptomonas antigens and IFAT, there was an association between CD4+ T lymphocyte counts and test positivity, with a higher positivity of these tests in more immunosuppressed patients (CD4+ T cell count < 200/mm3). Conclusions: According to our data, there was a high prevalence of Leishmania spp. infections in this population living with HIV. Although there is the possibility of cross-reaction, some tests that are considered highly specific for the diagnosis of Leishmania infection were positive. There was also an association between the positivity of some tests studied and lower values of CD4+ T lymphocytes. Keywords: Leishmaniasis, Acquired immunodeficiency syndrome, Diagnosis, Prevalence

Background Leishmaniasis is one of the most common neglected tropical diseases, and approximately 350 million people live in areas where there is a risk of infection [1]. In the Americas, 96% of visceral leishmaniasis (VL) cases occur in Brazil [2]. Considered a rural disease until 1980, VL * Correspondence: [email protected] 1 Department of Infectious Diseases, Federal University of Rio Grande do Norte, Rua Cônego Monte, 110, Quintas, Natal/RN, Rio Grande do Norte 59037-170, Brazil 2 Department of Infectious and Parasitic Diseases, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil Full list of author information is available at the end of the article

has spread in recent decades to large cities across the country. There was a decrease in the proportion of cases reported by the northeastern states and an increase in autochthonous transmission in larger cities (populations of > 100,000), including some cities in the state of Sao Paulo, [3] where this study is conducted. In PLWH, leishmaniasis may be an opportunistic infection, and coinfection has become a problem in several parts of the world, especially in East Africa, Brazil an