Leishmania and human immunodeficiency virus coinfection: the first 10 years.
Jorge Alvar,Carmen Cañavate,Beatriz Gutiérrez-Solar,Maribel Jiménez,Fernando Laguna,Rogelio López-Vélez,Ricardo Molina,Javier Moreno +7 more
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TLDR
Over 850 Leishmania-human immunodeficiency virus (HIV) coinfection cases have been recorded, the majority in Europe, where 7 to 17% of HIV-positive individuals with fever have amastigotes, suggesting that Leishmanniasis-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed.Abstract:
Over 850 Leishmania-human immunodeficiency virus (HIV) coinfection cases have been recorded, the majority in Europe, where 7 to 17% of HIV-positive individuals with fever have amastigotes, suggesting that Leishmania-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed. However, there are indirect reasons and statistical data demonstrating that intravenous drug addiction plays a specific role in Leishmania infantum transmission: an anthroponotic cycle complementary to the zoonotic one has been suggested. Due to anergy in patients with coinfection, L. infantum dermotropic zymodemes are isolated from patient viscera and a higher L. infantum phenotypic variability is seen. Moreover, insect trypanosomatids that are currently considered nonpathogenic have been isolated from coinfected patients. HIV infection and Leishmania infection each induce important analogous immunological changes whose effects are multiplied if they occur concomitantly, such as a Th1-to-Th2 response switch; however, the consequences of the viral infection predominate. In fact, a large proportion of coinfected patients have no detectable anti-Leishmania antibodies. The microorganisms share target cells, and it has been demonstrated in vitro how L. infantum induces the expression of latent HIV-1. Bone marrow culture is the most useful diagnostic technique, but it is invasive. Blood smears and culture are good alternatives. PCR, xenodiagnosis, and circulating-antigen detection are available only in specialized laboratories. The relationship with low levels of CD4+ cells conditions the clinical presentation and evolution of disease. Most patients have visceral leishmaniasis, but asymptomatic, cutaneous, mucocutaneous, diffuse cutaneous, and post-kala-azar dermal leishmaniasis can be produced by L. infantum. The digestive and respiratory tracts are frequently parasitized. The course of coinfection is marked by a high relapse rate. There is a lack of randomized prospective treatment trials; therefore, coinfected patients are treated by conventional regimens. Prophylactic therapy is suggested to be helpful in preventing relapses.read more
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CD4 + CD25 + regulatory T cells control Leishmania major persistence and immunity
Yasmine Belkaid,Yasmine Belkaid,Ciriaco A. Piccirillo,Susana Mendez,Ethan M. Shevach,David L. Sacks +5 more
TL;DR: It is shown that the persistence of Leishmania major in the skin after healing in resistant C57BL/6 mice is controlled by an endogenous population of CD4+CD25+ regulatory T cells, indicating that the equilibrium established between effector and regulatory T Cells in sites of chronic infection might reflect both parasite and host survival strategies.
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Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
TL;DR: The most recent version of the guidelines for the prevention and treatment of opportunistic infections (OI) in HIV-infected adults and adolescents was published in 2002 and 2004, respectively as mentioned in this paper.
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Visceral leishmaniasis: what are the needs for diagnosis, treatment and control?
François Chappuis,François Chappuis,Shyam Sundar,Asrat Hailu,H. W. Ghalib,Suman Rijal,Rosanna W. Peeling,Jorge Alvar,Marleen Boelaert +8 more
TL;DR: Millefosine, paromomycin and liposomal amphotericin B are gradually replacing pentavalent antimonials and conventional amphoteric in B as the preferred treatments in some regions, but in other areas these drugs are still being evaluated in both mono- and combination therapies.
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Drug Resistance in Leishmaniasis
TL;DR: It is essential that there be a strategy to prevent the emergence of resistance to new drugs; combination therapy, monitoring of therapy, and improved diagnostics could play an essential role in this strategy.
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The increase in risk factors for leishmaniasis worldwide.
TL;DR: Increasing risk factors are making leishmaniasis a growing public health concern for many countries around the world, and some are related to a specific eco-epidemiological entity, others affect all forms of leish maniasis.
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