Please Sign In or Create an account
Complex case report that illustrates the paucity of data for long term management of Visceral Leishmania-HIV co-infection.

Complex case report that illustrates the paucity of data for long term management of Visceral Leishmania-HIV co-infection.

HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.

Methods: Descriptive case report. results: A 58-year-old man, diagnosed with HIV-1 in 1985 was subsequently diagnosed with VL in 1996 on gut biopsy; the latter was unmasked through HIV-associated immunodeficiency as leishmania was likely acquired during childhood years in Greece. Challenge 1: presumed L.infantum infection, as formal speciation was only possible in 2003 using an in-house PCR. Challenge 2: although the WHO “gold standard” for monitoring disease burden is splenic aspiration and culture, no unit would perform this due to understandable safety concerns – instead repeated bone marrow biopsies were used to “quantify” disease burden. Challenge 3: between 1996-2012 in accordance with various “guidelines” – based largely on HIV-negative experience, the patient received, in addition to combination antiretroviral therapy (cART ), successive “induction-maintenance” with pentavalent antimonials; miltefosine (imported from Germany); liposomal amphotericin and monthly pentamidine with azoles (posaconazole on compassionate access, later fluconazole). There was rapid clinical failure and ultimately clinical evidence of pan-resistance to all anti-parasitics. Progressive renal impairment, liver cirrhosis (Challenge 4) and increasing fraility meant that parenteral paromomycin was not a viable treatment option. Challenge 5 – immune failure ultimately leading to death from recurrent gram negative sepsis arising from ulcerated skin lesions infiltrated with leishmania.
Conclusion: Further data on induction-maintenance strategies using combination VL-therapeutics coupled with improved microbiological techniques for diagnosis and monitoring in the HIV setting are urgently needed. Moreover, these VL-therapeutics and cART need to be affordable and accessible in countries with endemic HIV-VL co-infection.

Speakers: Melissa Kelly
Conference: ASHM 2013
Areas of Interest / Categories: AIDS 2013, HIV

AIDS 2013

Delayed HIV diagnoses among gay and bisexual men in Australia

The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.

Clinical factors associated with suboptimal adherence to antiretroviral therapy in Asia

Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.

Reinvigorating evidence for action and capacity in community HIV programs (REACH Project)

REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.

The impact of immune activation on natural killer cells in the setting of HIV infection

HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.

Men who take more risks avoid HIV testing due to structural barriers

Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.

A dramatic increase in the use of mobile apps to meet partners among gay men in Melbourne and Sydney is not associated with increased risk-taking: findings from the Gay Community Periodic Surveys, 2010-2013

In recent years there has been a widespread uptake of smartphones with internet access and location services and the development of mobile ‘apps’ for gay men to meet each other. We reviewed data collected in the Sydney and Melbourne Gay Community Periodic Surveys (GCPS) to identify which men were relying on mobile and internet methods to meet each other and whether these methods were associated with different risk practices.

Breaking out: HIV treatment and care when PLWHIV transtition from custodial settings into the community

Background: People Living with HIV (PLHIV) who are transitioning from custodial settings are at risk of experiencing treatment interruptions and loss to follow up for vital HIV care. The NSW Persons In Custody HIV Community Referral Project (PICHCRP) aims to ensure PLHIV who are transitioning from custodial settings back into the community receive seamless HIV service, care and support.