Visceral leishmaniasis is a common infection for HIV-positive patients in endemic countries. The presence of certain risk factors are associated with disease relapse and progression. These can help identify patients who may require more aggressive management and closer monitoring.


Relapses are relatively common in HIV-positive patients with a history of visceral leishmaniasis, even if taking HAART (page 297-298).


Risk factors for disease relapse (page 296):

(1) infection with a drug-resistant strain

(2) history of previous relapse

(3) female gender

(4) failure to adhere to therapy for visceral leishmaniasis

(5) failure to take secondary prophylaxis for visceral leishmaniasis while immunosuppressed

(6) persistence of anti-Leishmania antibodies (suggesting latent infection)


Risk factors for disease progression (page 297):

(1) presence of AIDS

(2) presence of severe AIDS-related diseases

(3) low CD4 count (< 200 per µL)

(4) presence of thrombocytopenia at the time of diagnosis of visceral leishmaniasis

(5) failure to adhere to therapy for visceral leishmaniasis or secondary prophylaxis

(6) failure to take HAART

(7) chronic relapsing course


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