Aranka Anema and Koert Ritimeijer1 describe their practical and effective strategy for treating visceral leishmaniasis (VL) in patients coinfected with HIV/AIDS in Ethiopia. Relying on low serologic titres of ≤ 1:400 to exclude VL is problematic, because titres of ≤ 1:400 might well be the result of patients with leishmaniasis having a grossly inadequate serologic response.
Coinfection with HIV and VL is documented to be associated with a poor serologic response. In Spain, among 120 patients with VL, including 80 coinfected with HIV, the serologic response was significantly lower among those coinfected with HIV.2 An identical scenario in Kafta Humera Woreda would lead to an underdiagnosis of VL and spoil the utility of an efficient decentralized diagnostic and therapeutic service.
It would be worthwhile to investigate at least some of those with serological titres of ≤ 1:400 for Leishmania donovani in their tissue aspirates. If costs are prohibitive in Ethiopia, then maybe the international community could help with this assay.
Subhash C. Arya Nirmala Agarwal Sant Parmanand Hospital Delhi, India
REFERENCES
- 1.Anema A, Ritmeijer K. Treating HIV/AIDS and leishmaniasis coinfection in Ethiopia. CMAJ 2005;172(11):1434-5. [DOI] [PMC free article] [PubMed]
- 2.Pintado V, Martin-Rabadau P, Rivera ML, Moeno S, Bouza E. Visceral leishmaniasis in human immunodeficiency virus (HIV)-infected and noninfected patients. A comparative study. Medicine 2001;80:54-73. [DOI] [PubMed]