People who are infected both with HIV and the Leishmania parasite get ill more often and are less susceptible to medicines. This is the case because both pathogens support and strengthen each other's effect. There is a strong need for international cooperation to exchange knowledge, not only in the clinical or biomedical field, but also in terms of public health and other social sciences.
To encourage this international and transdisciplinary collaboration, the scientific journal PLOS Neglected Tropical Diseases launches the Visceral Leishmaniasis-HIV Collection on August 28, in collaboration with Johan van Griensven (Institute of Tropical Medicine in Antwerp), Ed Zijlstra (Rotterdam Centre for Tropical Medicine) and Asrat Hail (Addis Ababa University), the authors of the collections' featured editorial, "Visceral Leishmaniasis and HIV Coinfection: Time for Concerted Action".
According to Johan van Griensven of the Institute of Tropical Medicine in Antwerp, we must involve all stakeholders in the collaboration: "In addition to an international multi-disciplinary approach, it is crucial that we strengthen the national control programs as well. It is important that the knowledge resulting from this cooperation can also influence health policies."
The Leishmania parasite causes visceral leishmaniasis, also known as 'kala-azar'. The disease causes fever, an enlarged spleen and other health problems. Visceral leishmaniasis is fatal in most cases, if left untreated. HIV patients co-infected with Leishmania have more parasites in their blood, making them more infectious.
Co-infection with HIV and the Leishmania parasite (VL-HIV co-infection) is a serious problem, especially in Ethiopia. Recent figures show that in some areas up to 40% of patients diagnosed with visceral leishmaniasis also have HIV. In South America, the number of cases with this co-infection has exceeded 6%. A recent study in India found a VL-HIV co-infection in 5.6% of the cases.
It is difficult to diagnose a person with visceral leishmaniasis when he or she is also infected with HIV, because simple serological tests are less accurate in this case. Molecular tests are more reliable in VL-HIV co-infection cases, but are rarely available in low and middle income countries.
The treatment of VL-HIV co-infection is complex because it makes drugs work less efficiently. Mortality figures reach 25% in some areas. Up to 60% of patients re-develop visceral leishmaniasis within a year. Because the patients go through a repeated and prolonged treatment, the risk that the parasites build up resistance to existing drugs increases.
Nevertheless, it is possible to control VL-HIV co-infection. We hope that with this collection, a new spotlight will be put on the current and needed research surrounding VL-HIV co-infection.