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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
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
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