Visceral leishmaniasis and HIV coinfection: current perspectives

José Angelo Lauletta Lindoso,1–3 Carlos Henrique Valente Moreira,1,4 Mirella Alves Cunha,5 Igor Thiago Queiroz6,7 1Instituto de Infectologia Emilio Ribas, São Paulo, Brazil; 2Nucleo de Medicina Tropical, Universidade de Brasília, Brasília, Brazil; 3Laboratorio de Soroepidemiologia, Institutode Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil; 4Laboratorio de Parasitologia, Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil; 5Departamento de Infectologia, Universidade Federal do Rio Grande do Norte, Natal, Brazil; 6Universidade Potiguar (UnP), Laureate International Universities, Natal, Brazil; 7Hospital Giselda Trigueiro (SESAP/RN), Natal, Brazil Abstract: Visceral leishmaniasis (VL) is caused by Leishmania donovani and Leishmania infantum. The burden of VL is concentrated in tropical and subtropical areas; however, HIV infection has spread VL over a hyperendemic area. Several outcomes are observed as a result of VL–HIV coinfection. Impacts are observed in immunopathogenesis, clinical manifestation, diagnosis, and therapeutic response. Concerning clinical manifestation, typical and unusual manifestation has been observed during active VL in HIV-infected patient, as well as alteration in immunoresponse, inducing greater immunosuppression by low CD4 T-lymphocyte count or even by induction of immunoactivation, with cell senescence. Serological diagnosis of VL in the HIV-infected is poor, due to low humoral response, characterized by antibody production, so parasitological methods are more recommended. Another important and even more challenging point is the definition of the best therapeutic regimen for VL in HIV-coinfected patients, because in this population there is greater failure and consequently higher mortality. The challenge of better understanding immunopathogenesis in order to obtain more effective therapies is one of the crucial points to be developed. The combination of drugs and the use of secondary prophylaxis associated with highly active antiretroviral therapy may be the best tool for treatment of HIV coinfection. Some derivatives from natural sources have action against Leishmania; however, studies have been limited to in vitro evaluation, without clinical trials. Keywords: visceral leishmaniasis, HIV infection, AIDS, diagnosis, therapeutic respons