Assessment of asymptomatic Leishmania infection in people living with HIV: a long-term follow-up study in Northeastern Brazil

In people living with HIV (PLWH), surveillance for <i>Leishmania</i> infection is crucial for identify those at risk of developing visceral leishmaniasis (VL). <i>Leishmania</i>-HIV coinfection worsens patient outcomes and increases mortality and relapse rates. We conducted a prospective study (2017-2023) in Northeast Brazil to assess the long-term outcomes of asymptomatic <i>Leishmania</i>-HIV coinfected outpatients and <i>Leishmania-</i>negative PLWH. Participants were drawn from a cross-sectional study performed in 2017, which identified both <i>Leishmania-</i>HIV coinfected and <i>Leishmania-</i>negative PLWH. Epidemiological, clinical, and laboratory data were collected from medical records (2017-2023). In 2023, these individuals were retested for <i>Leishmania</i> using serological tests and conventional polymerase chain reaction (PCR). Categorical variables were compared using the chi-square test, and non-parametric tests were used for quantitative variables. During follow-up, six individuals developed VL: five from the coinfected group and one from the non-coinfected PLWH group (OR 10.4; 95% CI 1.2-94.2; <i>p</i> = 0.023). Three patients experienced relapse: one from the PLWH group and two from the coinfected group. There was one death in the <i>Leishmania-</i>HIV group. In 2023, 80 patients were retested; five coinfected patients remained positive for VL by one or more tests, and two PLWH patients seroconverted for VL. Our findings underscore the critical need for long-term follow-up of asymptomatic <i>Leishmania</i>-HIV patients to mitigate disease progression and associated complications.