Revista de SIDA e investigación clínica

Profile of Patients’ Visceral Leishmaniasis-HIV co-infection in Kabylia

Abstract

Achour N, Bouhamed R and Harrat Z

Visceral Leishmaniasis (VL) disease, endemic to Algeria, is a major public health problem for children from rural areas and suffering from malnutrition, this disease currently tends to decrease. However, we found a constant progression in adults over the last twenty years. Indeed, 64 cases of VL in adults were recorded between 1991 and 2010 in Kabylia (Tizi-Ouzou, Bejaia and Bouira) with 18 cases with VL/HIV co-infections. Co-infected men is predominant with 15 cases, a sex ratio of 5 and an average age 35.57 +/- 2.3 years. Typical clinical signs, namely; fever, splenomegaly and hepatomegaly are observed only in 22.2% of the cases; absence of fever (n=4), splenomegaly (n=2), two (n=2) and presence lymphadenopathy (n=5). We also noted the presence of risk factors such as the advanced age of patients and late diagnosis of visceral leishmaniasis usually associated with the advanced stages of HIV infection (III, IV) in mostly multi-infected patients. We also identified five (5) cases of shingles and four (4) cases of digestive candidacies who were the most opportunistic infections observed in our series. Pancytopenia, observed in 2/3 of the cases has been the most consistent biological sign and contributing in the evocation of the VL as the clinical presentation was atypical. The confirmation, by direct examination of bone marrow smears by identifying amastigotes, is observed in all HIV patients (PVIH). Western blot and PCR techniques have allowed better monitoring of patients. In 5 cases, the VL revealed the infection of HIV. The care was difficult because of the numerous observed relapses. The unavailability of Amphotericin B, inherent in different factors, compelled us, in some situations, to use the Glucantime as first-line treatment (n=4). Prophylactic treatment based on Pentamidine (n=2), Glucantime (n=2) and amphotericin B (n=12). The evolution was marked by 5 deaths during the first days of treatment anti-Leishmanial and one after several relapses were observed as well as a resistance perhaps to Glucantime resulting in splenectomy.