Table 1.
Demographic and Clinical Characteristics of Patients With Visceral Leishmaniasis and HIV Coinfection Treated by Médecins Sans Frontières in Ethiopia From February 2008 to December 2013, by Visceral Leishmaniasis Relapse Status
| Characteristics at Admission | Total (N = 146) | VL Relapse (N = 44) | No VL Relapse (N = 102) | P |
|---|---|---|---|---|
| Sex, n (%) | ||||
| Male | 140 (95.9) | 43 (97.7) | 97 (95.1) | .67a |
| Female | 6 (4.1) | 1 (2.3) | 5 (4.9) | |
| Residential status, n (%); n = 142 | ||||
| Migrant worker | 70 (49.3) | 25 (59.5) | 45 (45.0) | .24a |
| Resident | 70 (49.3) | 17 (40.5) | 53 (53.0) | |
| Settler | 2 (1.4) | 0 (0.0) | 2 (2.0) | |
| Age (years), median (IQR) | 31 (27–38) | 30.5 (27−39) | 31.5 (27–37) | .61b |
| VL history, n (%) | ||||
| Primary VL | 110 (75.3) | 35 (79.6) | 75 (73.5) | .44c |
| Relapse VL | 36 (24.7) | 9 (20.4) | 27 (26.5) | |
| Spleen size (cm), median (IQR); n = 144 | 5 (3−8) | 5 (3−7) | 5 (3−8) | .72b |
| Body mass index (kg/m 2 ), median (IQR); n = 134 | 16 (15−18) | 16 (15−17) | 16 (15−18) | .96b |
| Hemoglobin (g/dL), median (IQR); n = 144 | 8.7 (7.2–10.1) | 9.2 (7.5−10.2) | 8.5 (6.9−9.8) | .14b |
| Parasitological test result at VL diagnosis, n (%)d | ||||
| <6+ | 84 (57.5) | 26 (59.1) | 58 (56.9) | .11c |
| 6+ | 22 (15.1) | 10 (22.7) | 12 (11.7) | |
| Not done: serological/clinical diagnosis | 40 (27.4) | 8 (18.2) | 32 (31.4) | |
| Tuberculosis, n (%); n = 145 | ||||
| Yes | 32 (22.1) | 10 (23.3) | 22 (21.6) | .82c |
| No | 113 (77.9) | 33 (76.7) | 80 (78.4) | |
| WHO stage, n (%); n = 111 | ||||
| III | 5 (4.5) | 1 (2.9) | 4 (5.3) | 1.00a |
| IV | 106 (95.5) | 34 (97.1) | 72 (94.7) | |
| CD4 count (cells/µL)e, median (IQR); n = 84 | 149 (65−256) | 139 (56−209) | 180 (74−278) | .19b |
| CD4 count (cells/µL), n (%)e; n = 84 | ||||
| ≤100 | 32 (38.1) | 11 (42.3) | 21 (36.2) | .75a |
| 101−199 | 21 (25.0) | 7 (26.9) | 14 (24.2) | |
| 200−349 | 19 (22.6) | 6 (23.1) | 13 (22.4) | |
| ≥350 | 12 (14.3) | 2 (7.7) | 10 (17.2) | |
| Advanced HIV infection, n (%)f; n = 133 | ||||
| Yes | 110 (82.7) | 36 (83.7) | 74 (82.2) | .83c |
| No | 23 (17.3) | 7 (16.3) | 16 (17.8) | |
| ART regimen, n (%)g | ||||
| Tenofovir-based regimen | 64 (43.8) | 15 (34.1) | 49 (48.0) | .01a |
| Non–tenofovir-based regimen | 76 (52.1) | 24 (54.5) | 52 (51.0) | |
| None | 6 (4.1) | 5 (11.4) | 1 (1.0) | |
| Timing of ART initiation, n (%); n = 144 | ||||
| ART initiated before VL episode | 57 (39.6) | 13 (29.6) | 44 (44.0) | .002a |
| Duration on ART (months) at VL diagnosis, median (IQR) | 6.8 (1.9−15.9) | 9.4 (4.1−29.6) | 5.7 (1.3−15.2) | |
| ART initiated during VL treatment | 40 (27.8) | 8 (18.2) | 32 (32.0) | |
| ART initiated after VL treatment | 41 (28.5) | 18 (40.9) | 23 (23.0) | |
| ART never initiated | 6 (4.2) | 5 (11.4) | 1 (1.0) | |
| Initial VL treatment regimen, n (%) | ||||
| AmBisome and Miltefosine | 59 (40.4) | 13 (29.6) | 46 (45.1) | .08c |
| Other (AmBisome or sodium stibogluconate) | 87 (59.6) | 31 (70.4) | 56 (54.9) | |
| Outcome of first VL episode treated, n (%); n = 139 | ||||
| Clinical cure | 82 (59.0) | 25 (59.5) | 57 (58.8) | .93c |
| Parasitological cure | 57 (41.0) | 17 (40.5) | 40 (41.2) | |
| Characteristics at discharge | ||||
| Spleen size (cm), median (IQR); n = 139 | 0 (0−3) | 0 (0−2) | 0 (0−3) | .21b |
| Body mass index (kg/m 2 ), median (IQR); n = 145 | 17 (16−18) | 17 (16−19) | 17 (16−18) | .37b |
| Hemoglobin (g/dL), median (IQR); n = 137 | 9.1 (8.2−10.5) | 8.9 (8.2−10.3) | 9.1 (8.2−10.5) | .96b |
| Duration of follow-up (months), median (IQR) | 11.4 (4.0−30.0) | 7.8 (3.9−15.3) | 14.4 (4.5−38.7) | .009b |
Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus; IQR, interquartile range; VL, visceral leishmaniasis;WHO, World Health Organization.
aFisher exact test.
b2-sample Wilcoxon rank-sum (Mann-Whitney) test.
cχ2 test.
d97 (66.4%) spleen aspirates, 1 bone marrow aspirate (0.7%), 8 lymph node aspirates (5.5%), and 40 (27.4%)—37 primary VL cases and 3 relapse cases—had no parasitological test done.
eCD4 count result is <6 months from VL treatment initiation.
fWHO stage IV or CD4 <50 cells/µL.
gStavudine, lamivudine, and nevirapine; zidovudine, lamivudine, and efavirenz; tenofovir, lamivudine, and efavirenz; zidovudine, lamivudine, and nevirapine; stavudine, lamivudine, and efavirenz.