Temporal analysis and factors associated with visceral leishmaniasis-HIV-AIDS coinfection in an endemic region of Brazil.

BACKGROUND

The rising incidence of visceral leishmaniasis (VL) and VL/Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (VL-HIV/AIDS) coinfection in parts of Brazil since the early 2000s underscores the need for research to better understand the dynamics of this dual disease burden. Previous analyses from 2000 to 2015 showed increasing trends in occurrence and mortality due to VL/HIV/AIDS. This study aimed to analyze temporal trends in VL and VL/HIV/AIDS coinfection and to identify associated factors.

METHODOLOGY/PRINCIPAL FINDINGS: We conducted an ecological time-series analysis combined with a cross-sectional study of all confirmed VL cases reported to the Brazilian Notifiable Diseases Information System among residents of Mato Grosso do Sul, Brazil, from 2012 to 2022, including VL-HIV/AIDS coinfections. Temporal trends were evaluated using Joinpoint regression with inflection points identified by the Monte Carlo permutation test. Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) were estimated with 95% confidence intervals. For the cross-sectional component, VL cases with and without HIV were compared using the chi-square and Mann-Whitney tests. Associated factors were identified through multivariable logistic regression with stepwise selection based on the Akaike Information Criterion. Multicollinearity was assessed using the variance inflation factor, and model fit was evaluated with the Hosmer-Lemeshow test. A significance level of p ≤ 0.05 was adopted. A total of 1,525 confirmed cases of VL were studied, of which 466 (30.55%) presented coinfection. Over the study period, the temporal trend of VL remained stable, while the highest incidence of coinfection occurred in 2022, reaching 1.99 cases per 100,000 inhabitants. Older age, male sex - (adjusted odds ratio [aOR]: 1.58; 95% confidence interval [CI]: 1.19-2.11), and clinical signs such as weight loss (aOR = 2.19; 95% CI: 1.64-2.93) and cough (aOR = 1.89; 95% CI: 1.44-2.49) were significantly associated with a higher likelihood of coinfection. In contrast, symptoms such as fever (aOR=0.28; CI = 0.22-0.37), edema (OR=0.48; CI = 0.36-0.65), splenomegaly (OR=0.52; CI = 0.41-0.65), hepatomegaly (OR=0.62; CI = 0.49-0.78), jaundice (OR=0.62; CI = 0.46-0.84), and other coinfections (OR=0.71; CI = 0.54-0.92) were less frequent among coinfected individuals.

CONCLUSIONS/SIGNIFICANCE: Specific clinical signs and symptoms differ in frequency between coinfected and non-coinfected individuals, which may help identify clinical patterns and improve differential diagnosis strategies. Although temporal trends indicate a stationary pattern over the past 11 years, strengthened interventions are still needed to reduce the incidence of VL-HIV/AIDS coinfection and mitigate its impact in endemic regions. Our findings highlight the importance of early clinical recognition of coinfection patterns and the implementation of targeted public health strategies to mitigate the impact of VL-HIV in endemic regions.