Clinical-Epidemiological Profile of Patients Coinfected With Hiv/AIds and Visceral Leishmaniasis at a Reference Hospital in Alagoas: A Retrospective Study

Visceral leishmaniasis (VL) is an opportunistic infection in people living with HIV, and this coinfection is emerging worldwide given the geographic overlap of these conditions. Owing to the synergistic pathophysiology of these infections (both progressing with depletion of CD4+ T lymphocytes), coinfected patients have atypical presentations, a higher chance of developing chronic VL, and a high risk of severe disease and death. This study aims to analyze the clinical-epidemiological characteristics of VL in patients with HIV/AIDS at a reference service in Alagoas between 2014 and 2023. Cross-sectional, retrospective, descriptive study with analysis of medical records of patients coinfected with VL–HIV/AIDS treated at a reference hospital in Alagoas. Of 40 records analyzed, 19 confirmed HIV/VL coinfection; most were men (78.9%), Brown-skinned and heterosexual (57.9%). Maceió had the most recorded cases. Sixty percent were diagnosed with HIV during hospitalization for VL. The mean time between infections was 2 years; about 11% had VL relapse with more than one hospitalization. The most common diagnostic method was rapid immunochromatographic testing (36%), followed by direct parasite detection in bone marrow aspirate. Hepatomegaly and fever were the most frequent manifestations, with a mean of 38 days from symptom onset to hospitalization. Laboratory findings showed 42% with pancytopenia or bicytopenia; mean AST was 79 U/L, with 90% above the reference range. Seventy percent required blood transfusion, 42% developed respiratory tract infection, 16% electrolyte disturbance, and 10% renal failure; there were 5 deaths (80% due to septic shock), yielding mortality of 26.31%. Deoxycholate amphotericin B was the most used therapy (57.9%), followed by the liposomal form (42.1%); 20% had the regimen changed to liposomal. HIV/VL coinfection in Alagoas reveals late HIV diagnosis and high severity, with VL coinfection being an important AIDS-defining condition given the high mortality (26.3%). The study underscores the importance of active HIV screening in VL endemic or suspected regions to anticipate diagnosis and optimize management.