{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:39:15Z","timestamp":1766428755698},"reference-count":23,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2002,3,1]],"date-time":"2002-03-01T00:00:00Z","timestamp":1014940800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2002,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>The way in which the extensive use of highly active antiretroviral therapy (HAART) has influenced the incidence of visceral leishmaniasis (VL) among human immunodeficiency type 1 (HIV-1)-infected patients is not yet understood. The present study assessed whether the incidence of symptomatic VL in HIV-infected patients has decreased since the introduction of HAART. Likewise, the role of other potential risk factors for VL was also analyzed. Therefore, 479 HIV-1-infected patients receiving antiretroviral treatment, according to the available drugs at each moment, were prospectively followed from April 1989 to June 2000 in two university hospitals in southern Spain. A bone marrow aspiration was performed when patients showed symptoms suggestive of kala-azar. A diagnosis of VL was made when<jats:italic>Leishmania<\/jats:italic>amastigotes were seen in Giemsa-stained samples or promastigotes were cultured in specific media. The median follow-up time was 1,380 [8 to 4,536] days. Twenty-one patients were diagnosed with symptomatic VL. The density of incidence of VL has decreased 64.8% as of January 1997, when HAART began to be used extensively in our area. The use of HAART was the main independent factor associated with VL; this therapy was a protective factor (adjusted hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.02 to 0.15). CDC clinical category C at entry in the cohort (HR, 4.08; 95% CI, 1.46 to 11.35) and CD4<jats:sup>+<\/jats:sup>cell counts below 300 cells\/mm<jats:sup>3<\/jats:sup>during the follow-up (HR, 3.96; 95% CI, 1.56 to 10.01) were also independently associated with kala-azar. A VL diagnosis prior to follow-up and low compliance with antiretroviral therapy were not independently associated with symptomatic VL, although statistical significance was almost reached (<jats:italic>P<\/jats:italic>= 0.1 and<jats:italic>P<\/jats:italic>= 0.08, respectively). In summary, the use of HAART has led to a fall in the incidence of symptomatic VL in HIV-infected patients. The main risk factor associated with kala-azar emergence in patients infected with HIV is deep immunosuppression.<\/jats:p>","DOI":"10.1128\/jcm.40.3.762-767.2002","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T09:58:35Z","timestamp":1027763915000},"page":"762-767","update-policy":"http:\/\/dx.doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":49,"title":["Incidence of and Risk Factors for Symptomatic Visceral Leishmaniasis among Human Immunodeficiency Virus Type 1-Infected Patients from Spain in the Era of Highly Active Antiretroviral Therapy"],"prefix":"10.1128","volume":"40","author":[{"given":"Rafael","family":"de la Rosa","sequence":"first","affiliation":[{"name":"Viral Hepatitis and AIDS Study Group, Servicio de Medicina Interna, Hospital Universitario Virgen del Roci\u0301o"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan A","family":"Pineda","sequence":"additional","affiliation":[{"name":"Servicio de Medicina Interna, Hospital Universitario de Valme, Seville"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Delgado","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and AIDS Study Group, Servicio de Medicina Interna, Hospital Universitario Virgen del Roci\u0301o"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Maci\u0301as","sequence":"additional","affiliation":[{"name":"Servicio de Medicina Interna, Hospital Universitario de Valme, Seville"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Morillas","sequence":"additional","affiliation":[{"name":"Departamento de Parasitologia, Facultad de Farmacia, Universidad de Granada, Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose\u0301 A.","family":"Mira","sequence":"additional","affiliation":[{"name":"Servicio de Medicina Interna, Hospital Universitario de Valme, Seville"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armando","family":"Sa\u0301nchez-Quijano","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and AIDS Study Group, Servicio de Medicina Interna, Hospital Universitario Virgen del Roci\u0301o"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Leal","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and AIDS Study Group, Servicio de Medicina Interna, Hospital Universitario Virgen del Roci\u0301o"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Lissen","sequence":"additional","affiliation":[{"name":"Viral Hepatitis and AIDS Study Group, Servicio de Medicina Interna, Hospital Universitario Virgen del Roci\u0301o"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","first-page":"25","volume":"10","year":"1994","unstructured":"Aebisher, T. 1994. 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