VISCERAL LEISHMANIASIS IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), s plenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%), In 79% of the patients, CD4+ cell counts were < 100 cells/mm(3), Prior or sim ultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis w as considered fortuitous In 19% of the episodes. In 27% of the episode s, the diagnosis was made on the basis of demonstration of parasites o utside the reticuloendothelial system, chiefly blood (7 cases) and gas trointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episo des). High antimony doses were more effective than low doses in achiev ing clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0 .11), Severe toxicity was observed in six (11.7%) of the 51 treated ep isodes, Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] an d CD4+ counts (OR 12, p < 0.05) were independent factors for early dea th. Prophylaxis with monthly pentamidine was not useful in reducing re lapses of visceral leishmaniasis.