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HIV-1 Co-Infection Increases Relapse Rate and Shortens Survival in Patients With Visceral Leishmaniasis

43 Pages Posted: 15 Dec 2021

See all articles by Yegnasew Takele

Yegnasew Takele

Imperial College London

Tadele Mulaw

University of Gondar

Emebet Adem

University of Gondar

Rebecca Womersley

Imperial College London

Myrsini Kaforou

Imperial College London - Section of Paediatric Infectious Disease

Susanne Ursula Franssen

Wellcome Genome Campus

Michael Levin

Imperial College London - Section of Paediatric Infectious Disease

Graham P. Taylor

Imperial College London - Section of Virology

Ingrid Müller

Imperial College London

James Anthony Cotton

Wellcome Genome Campus

Pascale Kropf

Imperial College London

More...

Abstract

Patients co-infected with visceral leishmaniasis (VL) and HIV-1 (VL/HIV patients) suffer from recurrent VL relapses and increased mortality. The aim of our study was to test the hypothesis that HIV patients who present with their first episode of VL (primary VL/HIV patients) experience less relapses and lower mortality as compared to VL/HIV patients who have a previous history of VL relapses (recurrent VL/HIV patients). Our results show that primary VL/HIV patients have a lower parasite load and that their relapse-free survival is significantly longer. Relapses in both groups of patients occur independently of HIV viral load. Our clinical and immunological analyses of these patients at the time of diagnosis and during follow-up show that the poorer prognosis of recurrent VL/HIV patients is accompanied by lower weight gain and lower recovery of all blood cell lineages, as well as lower production of antigen-specific IFNγ, lower CD4+ T cell counts and higher expression levels of the inhibitory receptor PD1 on CD4+ and CD8+ T cells.

Funding Information: YT is funded by a Wellcome Trust Training Fellowship in Public Health and Tropical Medicine (204797/Z/16/Z). This research was funded in part by the Wellcome Trust Grant (grant 206194, JAC). MK is funded by a Wellcome Trust Sir Henry Wellcome Fellowship (206508/Z/17/Z).

Declaration of Interests: The authors have declared that no conflict of interest exists.

Ethics Approval Statement: This study was approved by the Institutional Review Board of the University of Gondar (IRB, reference O/V/P/RCS/05/1572/2017), the National Research Ethics Review Committee (NRERC, reference 310/130/2018) and Imperial College Research Ethics Committee (ICREC 17SM480). Informed written consent was obtained from each patient and control.

Keywords: visceral leishmaniasis, HIV, visceral leishmaniasis relapse, co-infection, fever, body mass index, blood cell counts, CD4+ T cells, CD8+ T cells, PD1, interferon-gamma

Suggested Citation

Takele, Yegnasew and Mulaw, Tadele and Adem, Emebet and Womersley, Rebecca and Kaforou, Myrsini and Franssen, Susanne Ursula and Levin, Michael and Taylor, Graham P. and Müller, Ingrid and Cotton, James Anthony and Kropf, Pascale, HIV-1 Co-Infection Increases Relapse Rate and Shortens Survival in Patients With Visceral Leishmaniasis. Available at SSRN: https://ssrn.com/abstract=3986021 or http://dx.doi.org/10.2139/ssrn.3986021

Yegnasew Takele

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom

Tadele Mulaw

University of Gondar ( email )

Gondar, 196
Ethiopia

Emebet Adem

University of Gondar ( email )

Gondar, 196
Ethiopia

Rebecca Womersley

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom

Myrsini Kaforou

Imperial College London - Section of Paediatric Infectious Disease

Susanne Ursula Franssen

Wellcome Genome Campus ( email )

Hinxton
Cambridge, England CB10 1SA
United Kingdom

Michael Levin

Imperial College London - Section of Paediatric Infectious Disease ( email )

London
United Kingdom

Graham P. Taylor

Imperial College London - Section of Virology ( email )

Ingrid Müller

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom

James Anthony Cotton

Wellcome Genome Campus ( email )

Hinxton
Cambridge, England CB10 1SA
United Kingdom

Pascale Kropf (Contact Author)

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom