Fatores associados a ocorrência de coinfecção Leishmania/HIV-AIDS na região Norte do Tocantins

Abstract

Leishmaniasis is an endemic zoonosis in several countries, amongst them is Brazil, and it's association with the infection caused by the human immunodeficiency virus (HIV) is considered a highly severe disease, whose incidence has been rising in the last few years, due to the urbanization of this disease, associated to the interiorization of HIV infection cases. In Brazil, the state of Tocantins is considered an endemic area for both cutaneous and visceral forms of leishmaniasis, which encouraged the study development with the purpose of understanding the factors related to leishmaniasis/HIV-AIDS coinfection affecting individuals that are assisted by the brazilian health system in the northern state. A retrospective crosssectional study has been conducted by collecting data from medical records of individuals treated at the Hospital of Tropical Diseases of the Federal University at North of Tocantins from 2010 to 2020, supplemented by data obtained from Municipal Health Department of Araguaina- TO. Information was obtained using a structured form, and associations were tested through univariate analysis using Mantel-Hanzel chi squared test. Variables presenting p<0,10 were submitted to multivariate analysis using logistic regression. Mann-Whitney test was used to analyze quantitative variables. Were include 53 records of individuals with leishmaniasis/HIVAIDS coinfection, 106 subjects with HIV-AIDS infection and 106 subjects with leishmaniasis infection, totalizing 265 participants of any gender, race/ethnicity, marital status, education level and profession, with age group above 15 years-old, from the municipalities of northern region of Tocantins. Most cases of leishmaniasis/HIV-AIDS coinfection comprised males (71,7%), between 15 and 39 years (60,38%), single (75,47%), brown (92,45%) and with poor education (52,83%). Fever, splenomegaly, hepatomegaly, weight loss and weakness were the most common symptoms in coinfection. The most frequently performed laboratory exams were the serological tests and the medication more prescribed was the liposomal amphotericin B (58,49%), evolving for the cure, in the majority of cases treated for leishmaniasis (88,68%). When comparing individuals with leishmaniasis/HIV-AIDS co-infection with HIV positive individuals, there was a greater chance of having splenomegaly (OR: 18.55) and hepatomegaly (OR: 4.58) in HIV-AIDS coinfected, while in comparison with individuals infected only by Leishmania, inappetence was presented as a risk factor (OR: 3,80), however low schooling (OR: 0.319) and the presence of fever (OR: 0.260) were associated as a protective factor for coinfection, when submitted to multivariate analysis. The results obtained by this study showed that individual characteristics little interfered with the chances of leishmaniasis/HIV-AIDS occurrence, and demonstrated that leishmaniasis clinical characteristics are significantly higher in this group. It is suggested that in visceral leishmaniasis and HIV-AIDS endemic areas the clinical and laboratorial diagnostic be prioritized, aiming to minimize the impacts of late recognition of coinfection.