Document 0431
 DOCN  M9590431
 TI    Visceral leishmaniasis and HIV-1 co-infection in southern France.
 DT    9509
 AU    Rosenthal E; Marty P; Poizot-Martin I; Reynes J; Pratlong F; Lafeuillade
       A; Jaubert D; Boulat O; Dereure J; Gambarelli F; et al; Department of
       Internal Medicine, University Hospital, Nice,; France.
 SO    Trans R Soc Trop Med Hyg. 1995 Mar-Apr;89(2):159-62. Unique Identifier :
       AIDSLINE MED/95296988
 AB    Between 1986 and 1993 visceral leishmaniasis (VL) was diagnosed in 50
       adult patients with human immunodeficiency virus type 1 (HIV-1)
       infection (8 females, 42 males: 31 intravenous drug users, 11 homosexual
       or bisexual men, 6 heterosexual individuals, 2 blood recipients) from 5
       hospital centres in southern France. Diagnosis of VL was by
       demonstration of Leishmania and isolation of promastigotes by culture in
       Novy-McNeal-Nicolle medium. Leishmania isolates were identified by their
       isoenzyme profile in 28 patients. All the patients were
       immunocompromised when VL was diagnosed. Their median CD4 cell count was
       25 x 10(6) (0-200). However, only 21 patients (42%) fulfilled the 1987
       CDC criteria for the acquired immune deficiency syndrome before VL
       developed. Fever (84%), splenomegaly (56%), hepatomegaly (34%), and
       pancytopenia (62%) were the most common presenting features. Clinical
       signs were lacking in 10% of patients. Anti-leishmanial antibodies were
       detected by indirect immunofluorescence or enzyme-linked immunosorbent
       assay in 26/47 cases (55%). Combining these techniques with Western
       blotting (WB) gave a positivity rate of 95%. Amastigotes were
       demonstrated in bone marrow aspirates in 47 cases (94%). Unusual sites
       for parasites were found in 17 patients (34%), mainly in the digestive
       tract but also skin and lung. Viscerotropic L. infantum zymodeme MON-1
       was characterized in 86% of cases. Dermotropic zymodemes MON-24, MON-29,
       MON-33, and a previously undescribed zymodeme MON-183, were isolated
       from 4 patients. The response rate to pentavalent antimony was 50% and
       to amphotericin B 100%, but clinical relapses were noted in both groups.
       In endemic areas, VL should be considered as a possible opportunistic
       infection in HIV-infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)
 DE    Adult  Aged  Amphotericin B/THERAPEUTIC USE  Antibodies,
       Protozoan/ANALYSIS  Antimony Sodium Gluconate/THERAPEUTIC USE
       AIDS-Related Opportunistic Infections/*COMPLICATIONS/EPIDEMIOLOGY
       Female  France/EPIDEMIOLOGY  Human  *HIV-1  Leishmaniasis,
       Visceral/*COMPLICATIONS/DRUG THERAPY/EPIDEMIOLOGY  Male  Middle Age
       Retrospective Studies  Treatment Outcome  JOURNAL ARTICLE

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