Visceral Leishmaniasis-HIV Coinfection as a Predictor of Increased Leishmania Transmission at the Village Level in Bihar, India.
Visceral Leishmaniasis-HIV Coinfection as a Predictor of Increased Leishmania Transmission at the Village Level in Bihar, India.
复制标题
DOI：
10.3389/fcimb.2021.604117
复制
发表时间：
2021
影响因子：
5.7
通讯作者：
Hasker E
中科院分区：
文献类型：
--
作者：
Cloots K;Marino P;Burza S;Gill N;Boelaert M;Hasker E
内脏利什曼病(VL)作为印度次大陆的一个公共卫生问题正处于被消灭的边缘。尽管黑热病后皮肤利什曼病(PKDL)被认为是重要的传播宿主，但我们推测，合并人类免疫缺陷病毒(HIV)感染的VL患者也可能是持续传播利什曼病的重要宿主。因此，我们调查了PKDL或VL-HIV病例在多大程度上与印度比哈尔邦村庄一级的VL发病率有关。2014-2019年，通过Kala-Azar管理信息系统收集了印度VL高度流行的比哈尔邦六个区的VL、VL-HIV和PKDL病例数据。多因素分析采用年负二项回归控制为固定效应，区(区)为随机效应。VL-HIV+和PKDL病例的存在都与村级VL-HIV+和PKDL病例的发病率增加两倍以上相关，VL-HIV+和PKDL病例的发病率比(IRR)分别为2.16(95%CI 1.81~2.58)和2.37(95%CI 2.01~2.81)。敏感性分析表明，在所包括的六个分区中，每个分区的关联强度都是相似的。这些发现表明VL-HIV+患者作为利什曼原虫感染源的重要性，并表明他们构成了相当于PKDL患者对印度次大陆消除VL倡议的威胁，因此需要进行类似的关注。
Visceral leishmaniasis (VL) is on the verge of being eliminated as a public health problem in the Indian subcontinent. Although Post-kala-azar dermal leishmaniasis (PKDL) is recognized as an important reservoir of transmission, we hypothesized that VL patients co-infected with Human Immunodeficiency Virus (HIV) may also be important reservoirs of sustained leishmania transmission. We therefore investigated to what extent cases of PKDL or VL-HIV are associated with VL incidence at the village level in Bihar, India. VL, VL-HIV, and PKDL case data from six districts within the highly VL-endemic state of Bihar, India were collected through the Kala-Azar Management Information System for the years 2014–2019. Multivariate analysis was done using negative binomial regression controlling for year as a fixed effect and block (subdistrict) as a random effect. Presence of VL-HIV+ and PKDL cases were both associated with a more than twofold increase in VL incidence at village level, with Incidence Rate Ratios (IRR) of 2.16 (95% CI 1.81–2.58) and 2.37 (95% CI 2.01–2.81) for VL-HIV+ and PKDL cases respectively. A sensitivity analysis showed the strength of the association to be similar in each of the six included subdistricts. These findings indicate the importance of VL-HIV+ patients as infectious reservoirs for Leishmania, and suggest that they represent a threat equivalent to PKDL patients towards the VL elimination initiative on the Indian subcontinent, therefore warranting a similar focus.