We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
The Risk and Predictors of Visceral Leishmaniasis Relapse in Human Immunodeficiency Virus-Coinfected Patients in Ethiopia: A Retrospective Cohort Study.
- Authors
Abongomera, Charles; Diro, Ermias; Vogt, Florian; Tsoumanis, Achilleas; Mekonnen, Zelalem; Admassu, Henok; Colebunders, Robert; Mohammed, Rezika; Ritmeijer, Koert; van Griensven, Johan
- Abstract
Background. East Africa, where Leishmania donovani is prevalent, faces the highest burden world-wide of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) coinfection. However, data on the risk and predictors of VL relapse are scarce. Such information is vital to target medical follow-up and interventions to those at highest risk. Methods. We conducted a retrospective cohort study at a Médecins Sans Frontières-supported health center in northwest Ethiopia. We included adult VL-HIV coinfected patients treated for VL and discharged cured between February 2008 and February 2013. The risk of relapse was calculated using Kaplan-Meier methods, and predictors were determined using Cox regression models. Results. Of the 146 patients included, 140 (96%) were male and the median age was 31 years. At the index VL diagnosis, 110 (75%) had primary VL, 57 (40%) were on antiretroviral therapy (ART), and the median CD4 count was 149 cells/μL. The median follow-up time after cure was 11 months, during which 44 (30%) patients relapsed. The risk of relapse was 15% at 6 months, 26% at 12 months, and 35% at 24 months. Predictors of relapse were: not being on ART at VL diagnosis, ART not initiated during VL treatment, and high tissue parasite load (parasite grade 6+) at VL diagnosis. Conclusions. The risk of VL relapse in coinfected patients was high, particularly in those not on ART or presenting with a high tissue parasite load. These patients should be preferentially targeted for secondary prophylaxis and/or regular medical follow-up. Timely ART initiation in all coinfected patients is crucial.
- Subjects
ETHIOPIA; DISEASE relapse; HIV infections; LEISHMANIASIS; PROPORTIONAL hazards models; RETROSPECTIVE studies; KAPLAN-Meier estimator; MIXED infections
- Publication
Clinical Infectious Diseases, 2017, Vol 65, Issue 10, p1703
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cix607