ArticleJournal of clinical microbiology2002
Incidence of and risk factors for symptomatic visceral leishmaniasis among human immunodeficiency virus type 1-infected patients from Spain in the era of highly active antiretroviral therapy.
Article in Journal of clinical microbiology, 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 67 citations in OpenAlex.
- Prevalence of visceral leishmaniasis among people with HIV: a systematic review and meta-analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2023Pooled it
- T-cell activation and senescence in asymptomatic HIV/Leishmania infantum co-infection.PLoS neglected tropical diseases · 2025Article
- Incidence and persistence of asymptomatic Leishmania infection among HIV-infected patients in Trang province, Southern Thailand: A cohort study.PLoS neglected tropical diseases · 2024Article
- Signal peptide peptidase: a potential therapeutic target for parasitic and viral infections.Expert opinion on therapeutic targets · 2022Review
- Crystal structure of the retroviral protease-like domain of a protozoal DNA damage-inducible 1 protein.FEBS open bio · 2018Article
- Prevalence of Human Immunodeficiency Virus and associated factors among Visceral Leishmaniasis infected patients in Northwest Ethiopia: a facility based cross-sectional study.BMC infectious diseases · 2017Article
- Magnitude of visceral leishmaniasis and poor treatment outcome among HIV patients: meta-analysis and systematic review.HIV/AIDS (Auckland, N.Z.) · 2016Article
- Risk Factors for Death from Visceral Leishmaniasis in an Urban Area of Brazil.PLoS neglected tropical diseases · 2015Article
- Five-year retrospective Italian multicenter study of visceral leishmaniasis treatment.Antimicrobial agents and chemotherapy · 2014Article
- Leishmaniasis: new insights from an old and neglected disease.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2012Review
- Parasitic infections in HIV infected individuals: diagnostic & therapeutic challenges.The Indian journal of medical research · 2011Review
- Protease expression by microorganisms and its relevance to crucial physiological/pathological events.World journal of biological chemistry · 2011Article
- Methods of Control of the Leishmania infantum Dog Reservoir: State of the Art.Veterinary medicine international · 2011Article
- Importance of nonenteric protozoan infections in immunocompromised people.Clinical microbiology reviews · 2010Review
- Visceral Leishmaniasis treated with antimonials/paromomycin followed by itraconazole/miltefosine after standard therapy failures in a human immunodeficiency virus-infected patient.The American journal of tropical medicine and hygiene · 2010Article
- The relationship between leishmaniasis and AIDS: the second 10 years.Clinical microbiology reviews · 2008Review
- Parasitic central nervous system infections in immunocompromised hosts: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2006Review
- Leishmaniasis as an opportunistic infection in HIV-infected patients: determinants of relapse and mortality in a collaborative study of 228 episodes in a Mediterreanean region.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2005Article
- Leishmaniasis: new approaches to disease control.BMJ (Clinical research ed.) · 2003Review
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The way in which the extensive use of highly active antiretroviral therapy (HAART) has influenced the incidence of visceral leishmaniasis (VL) among human immunodeficiency type 1 (HIV-1)-infected patients is not yet understood. The present study assessed whether the incidence of symptomatic VL in HIV-infected patients has decreased since the introduction of HAART. Likewise, the role of other potential risk factors for VL was also analyzed. Therefore, 479 HIV-1-infected patients receiving antiretroviral treatment, according to the available drugs at each moment, were prospectively followed from April 1989 to June 2000 in two university hospitals in southern Spain. A bone marrow aspiration was performed when patients showed symptoms suggestive of kala-azar. A diagnosis of VL was made when Leishmania amastigotes were seen in Giemsa-stained samples or promastigotes were cultured in specific media. The median follow-up time was 1,380 [8 to 4,536] days. Twenty-one patients were diagnosed with symptomatic VL. The density of incidence of VL has decreased 64.8% as of January 1997, when HAART began to be used extensively in our area. The use of HAART was the main independent factor associated with VL; this therapy was a protective factor (adjusted hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.02 to 0.15). CDC clinical category C at entry in the cohort (HR, 4.08; 95% CI, 1.46 to 11.35) and CD4(+) cell counts below 300 cells/mm(3) during the follow-up (HR, 3.96; 95% CI, 1.56 to 10.01) were also independently associated with kala-azar. A VL diagnosis prior to follow-up and low compliance with antiretroviral therapy were not independently associated with symptomatic VL, although statistical significance was almost reached (P = 0.1 and P = 0.08, respectively). In summary, the use of HAART has led to a fall in the incidence of symptomatic VL in HIV-infected patients. The main risk factor associated with kala-azar emergence in patients infected with HIV is deep immunosuppression.
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