American tegumentary leishmaniasis and HIV-AIDS association in a tertiary care center in the Brazilian Amazon

Abstract

American tegumentary leishmaniasis (ATL) and human immunodeficiency virus (HIV) are both common infectious diseases in the Brazilian Amazon with overlapping expansion areas, which leads to the occurrence of Leishmania /HIV coinfection. Most ATL/HIV-acquired immunodeficiency syndrome (AIDS) association cases have been reported from areas where Leishmania ( Viannia ) braziliensis is the main pathogen; this finding is in contrast with the Amazon region, where L. ( V. ) guyanensis is the most implicated agent, implying distinct clinical and therapeutic aspects. We describe 15 cases of ATL/HIV coinfection treated in a tertiary care center in the Brazilian Amazon between 1999 and 2008. Thirteen patients presented with diverse clinical manifestations of cutaneous leishmaniasis, and four of them had disseminated forms; two patients presented with mucosal leishmaniasis (ML). Seven patients required more than one course of treatment. The particularities of ATL/HIV-AIDS association in L. ( V. ) guyanensis -endemic areas require efforts for an increased understanding of its burden and subsequent improvements in case management. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.