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de Moraes L, Santos LA, Arruda LB, da Silva MDPP, Silva MDO, Silva JAG, Ramos A, dos Santos MB, Torres FG, Orge C, Teixeira AMDS, Vieira TS, Ramírez L, Soto M, Grassi MFR, de Siqueira IC, Costa DL, Costa CHN, Andrade BDB, Akrami K, de Oliveira CI, Boaventura VS, Barral-Netto M, Barral A, Vandamme AM, Van Weyenbergh J, Khouri R. High seroprevalence of Leishmania infantum is linked to immune activation in people with HIV: a two-stage cross-sectional study in Bahia, Brazil. Front Microbiol 2023; 14:1221682. [PMID: 37601355 PMCID: PMC10436095 DOI: 10.3389/fmicb.2023.1221682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Visceral leishmaniasis is an opportunistic disease in HIV-1 infected individuals, unrecognized as a determining factor for AIDS diagnosis. The growing geographical overlap of HIV-1 and Leishmania infections is an emerging challenge worldwide, as co-infection increases morbidity and mortality for both infections. Here, we determined the prevalence of people living with HIV (PWH) with a previous or ongoing infection by Leishmania infantum and investigated the virological and immunological factors associated with co-infection. We adopted a two-stage cross-sectional cohort (CSC) design (CSC-I, n = 5,346 and CSC-II, n = 317) of treatment-naïve HIV-1-infected individuals in Bahia, Brazil. In CSC-I, samples collected between 1998 and 2013 were used for serological screening for leishmaniasis by an in-house Enzyme-Linked Immunosorbent Assay (ELISA) with SLA (Soluble Leishmania infantum Antigen), resulting in a prevalence of previous or ongoing infection of 16.27%. Next, 317 PWH were prospectively recruited from July 2014 to December 2015 with the collection of sociodemographic and clinical data. Serological validation by two different immunoassays confirmed a prevalence of 15.46 and 8.20% by anti-SLA, and anti-HSP70 serology, respectively, whereas 4.73% were double-positive (DP). Stratification of these 317 individuals in DP and double-negative (DN) revealed a significant reduction of CD4+ counts and CD4+/CD8+ ratios and a tendency of increased viral load in the DP group, as compared to DN. No statistical differences in HIV-1 subtype distribution were observed between the two groups. However, we found a significant increase of CXCL10 (p = 0.0076) and a tendency of increased CXCL9 (p = 0.061) in individuals with DP serology, demonstrating intensified immune activation in this group. These findings were corroborated at the transcriptome level in independent Leishmania- and HIV-1-infected cohorts (Swiss HIV Cohort and Piaui Northeast Brazil Cohort), indicating that CXCL10 transcripts are shared by the IFN-dominated immune activation gene signatures of both pathogens and positively correlated to viral load in untreated PWH. This study demonstrated a high prevalence of PWH with L. infantum seropositivity in Bahia, Brazil, linked to IFN-mediated immune activation and a significant decrease in CD4+ levels. Our results highlight the urgent need to increase awareness and define public health strategies for the management and prevention of HIV-1 and L. infantum co-infection.
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Affiliation(s)
- Laise de Moraes
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Luciane Amorim Santos
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, United Kingdom
| | | | - Márcio de Oliveira Silva
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - José Adriano Góes Silva
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - André Ramos
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | | | | | - Cibele Orge
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | | | - Laura Ramírez
- Departamento de Biología Molecular, Facultad de Ciencias, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel Soto
- Departamento de Biología Molecular, Facultad de Ciencias, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Fernanda Rios Grassi
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | - Dorcas Lamounier Costa
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Carlos Henrique Nery Costa
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Bruno de Bezerril Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Kevan Akrami
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Camila Indiani de Oliveira
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Viviane Sampaio Boaventura
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Hospital Santa Izabel, Salvador, Brazil
| | - Manoel Barral-Netto
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Aldina Barral
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
| | - Ricardo Khouri
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
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Costa LDLN, Lima US, Rodrigues V, Lima MIS, Silva LA, Ithamar J, Azevedo CMPS. Factors associated with relapse and hospital death in patients coinfected with visceral leishmaniasis and HIV: a longitudinal study. BMC Infect Dis 2023; 23:141. [PMID: 36882732 PMCID: PMC9993705 DOI: 10.1186/s12879-023-08009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/16/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Visceral leishmaniasis (VL) is an endemic parasitic disease in Latin America, and its clinical picture is aggravated in coinfections with the human immunodeficiency virus (HIV). The objective of this study was to investigate clinical factors and laboratory variables associated with VL relapse and death in VL/HIV coinfected patients. METHODS A prospective longitudinal study was conducted from January 2013 to July 2020 among 169 patients coinfected with VL and HIV. The outcomes investigated were the occurrence of VL relapse and death. Chi-square test, Mann-Whitney test and logistic regression models were used for statistical analysis. RESULTS The occurrence rates were 41.4% for VL relapse and 11.2% for death. Splenomegaly and adenomegaly were associated with the increased risk of VL relapse. Patients with VL relapse had higher levels of urea (p = .005) and creatinine (p < .001). Patients who died had lower red blood cell counts (p = .012), hemoglobin (p = .017) and platelets (p < .001). The adjusted model showed that antiretroviral therapy for more than 6 months was associated with a decrease in VL relapse, and adenomegaly was associated with an increase in VL relapse. In addition, edema, dehydration, poor general health status, and paleness were associated with an increase in hospital death. CONCLUSION The findings suggest that adenomegaly, antiretroviral therapy, and renal abnormalities can be associated with VL relapse, while hematological abnormalities, and clinical manifestations like paleness, and edema can be associated with an increased odds of hospital death. TRIAL REGISTRATION NUMBER The study was submitted to the Ethics and Research Committee of the Federal University of Maranhão (Protocol: 409.351).
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Affiliation(s)
- Larissa D L N Costa
- Health Sciences Graduate Program, Federal University of Maranhão, Avenida dos Portugueses, 1966, Bacanga, São Luís, Maranhão, 65080-806, Brazil.
| | - Uiara S Lima
- Health Sciences Graduate Program, Federal University of Maranhão, Avenida dos Portugueses, 1966, Bacanga, São Luís, Maranhão, 65080-806, Brazil
| | - Vandilson Rodrigues
- Department of Morphology, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Mayara I S Lima
- Health and Environment Graduate Program, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Lucilene A Silva
- Health Sciences Graduate Program, Federal University of Maranhão, Avenida dos Portugueses, 1966, Bacanga, São Luís, Maranhão, 65080-806, Brazil
| | - Jorim Ithamar
- President Vargas State Hospital, São Luís, Maranhão, Brazil
| | - Conceição M P S Azevedo
- Health Sciences Graduate Program, Federal University of Maranhão, Avenida dos Portugueses, 1966, Bacanga, São Luís, Maranhão, 65080-806, Brazil.,President Vargas State Hospital, São Luís, Maranhão, Brazil.,Department of Medicine, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Foinquinos J, Duarte MDC, Figueiroa JN, Correia JB, Cavalcanti NV. Temporal Validation of a Predictive Score for Death in Children with Visceral Leishmaniasis. J Trop Med 2021; 2021:6688444. [PMID: 34976072 PMCID: PMC8716242 DOI: 10.1155/2021/6688444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To perform a temporal validation of a predictive model for death in children with visceral leishmaniasis (VL). METHODS A temporal validation of a children-exclusive predictive model of death due to VL (Sampaio et al. 2010 model), using a retrospective cohort, hereby called validation cohort. The validation cohort convenience sample was made of 156 patients less than 15 years old hospitalized between 2008 and 2018 with VL. Patients included in the Sampaio et al. 2010 study are here denominated derivation cohort, which was composed of 546 patients hospitalized in the same hospital setting in the period from 1996 to 2006. The calibration and discriminative capacity of the model to predict death by VL in the validation cohort were then assessed through the procedure of logistic recalibration that readjusted its coefficients. The calibration of the updated model was tested using Hosmer-Lemeshow test and Spiegelhalter test. A ROC curve was built and the value of the area under this curve represented the model's discrimination. RESULTS The validation cohort found a lethality of 6.4%. The Sampaio et al. 2010 model demonstrated inadequate calibration in the validation cohort (Spiegelhalter test: p=0.007). It also presented unsatisfactory discriminative capacity, evaluated by the area under the ROC curve = 0.618. After the coefficient readjustment, the model showed adequate calibration (Spiegelhalter test, p=0.988) and better discrimination, becoming satisfactory (AUROC = 0.762). The score developed by Sampaio et al. 2010 attributed 1 point to the variables dyspnea, associated infections, and neutrophil count <500/mm3; 2 points to jaundice and mucosal bleeding; and 3 points to platelet count <50,000/mm3. In the recalibrated model, each one of the variables had a scoring of 1 point for each. CONCLUSION The temporally validated model, after coefficient readjustment, presented adequate calibration and discrimination to predict death in children hospitalized with VL.
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Affiliation(s)
| | | | | | - Jailson B. Correia
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
- Universidade de Pernambuco, Recife, Brazil
- Faculdade Pernambucana de Saúde, Recife, Brazil
| | - Nara Vasconcelos Cavalcanti
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
- Universidade de Pernambuco, Recife, Brazil
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Ribeiro CJN, dos Santos AD, Lima SVMA, da Silva ER, Ribeiro BVS, Duque AM, Peixoto MVS, dos Santos PL, de Oliveira IM, Lipscomb MW, de Araújo KCGM, de Moura TR. Space-time risk cluster of visceral leishmaniasis in Brazilian endemic region with high social vulnerability: An ecological time series study. PLoS Negl Trop Dis 2021; 15:e0009006. [PMID: 33465104 PMCID: PMC7846114 DOI: 10.1371/journal.pntd.0009006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/29/2021] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. OBJECTIVE To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. METHODS We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics. RESULTS Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. CONCLUSIONS VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.
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Affiliation(s)
- Caique J. N. Ribeiro
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | | | - Shirley V. M. A. Lima
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Department of Nursing, Federal University of Sergipe, Lagarto, Brazil
| | | | - Bianca V. S. Ribeiro
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Andrezza M. Duque
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
| | - Marcus V. S. Peixoto
- Department of Speech Therapy and Audiology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Priscila L. dos Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Iris M. de Oliveira
- Department of Functional Biology and Health Sciences, University of Vigo, Pontevedra, Spain
| | - Michael W. Lipscomb
- Department of Biology, Howard University, Washington DC, United States of America
| | - Karina C. G. M. de Araújo
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
| | - Tatiana R. de Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil
- Graduate Program in Parasite Biology, Federal University of Sergipe, São Cristóvão, Brazil
- * E-mail:
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Almeida ÂS, Ribeiro CJN, Carlini CC, Santos RS, Dos Santos AD, Tavares DS, De Araújo KCGM, Moura TRD, Santos PLD. Spatial and spatiotemporal dynamics of visceral leishmaniasis in an endemic North-eastern region of Brazil. GEOSPATIAL HEALTH 2021; 15. [PMID: 33461273 DOI: 10.4081/gh.2020.885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/02/2020] [Indexed: 06/12/2023]
Abstract
Visceral Leishmaniasis (VL) is a neglected disease with increasing incidence in Brazil, particularly in the North-eastern. The aim of this study was to analyze the spatial and spatiotemporal dynamics of VL in an endemic region of North-eastern Brazil, between 2009 and 2017. Using spatial analysis techniques, an ecological and time series study was made regarding VL cases in Sergipe filed as notifiable disease events. With data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), a digital population and cartographic baseline was established. Segmented linear regression was used to examine the temporal trends. The statistical analysis methods of Global and Local Moran' I, local Bayesian empirical methodology and spatial-temporal scanning were used to produce thematic maps. High instances were found among adults, males, urban residents, non-Whites and persons with low levels of education. A decrease in the recovery rate and an increase in the proportion of urban cases and lethality was found. A heterogeneous VL distribution with spatiotemporal agglomeration on the seaside of the state was seen in Sergipe. To better manage the disease, new research is encouraged together with development of public health strategies. Further, improving health care networks, especially primary care, is suggested as this approach has a key role in health promotion, prevention and monitoring of the most prevalent diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Tatiana Rodrigues de Moura
- Postgraduate in Health Sciences, Federal University of Sergipe, São Cristóvão; Department of Pharmacy, Federal University of Sergipe, Lagarto.
| | - Priscila Lima Dos Santos
- Postgraduate in Applied Health Sciences, Federal University of Sergipe, Lagarto; Postgraduate in Health Sciences, Federal University of Sergipe, São Cristóvão; Department of Health Education, Federal University of Sergipe, Lagarto, Sergipe.
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