|Report on a Training Workshop on Voluntary Counselling and Testing (VCT) for LEISHMANIA/HIV (UNAIDS, 1999, 20 p.)|
Leishmaniasis is a protozoan disease spread by the bite of the sandfly. Transmission can be anthroponotic or zoonotic with different animal reservoirs in different parts of the world. There are twenty or more species of leishmania and the symptoms of the disease vary with the infecting species and with host factors. The disease is present in cutaneous, diffuse cutaneous, mucocutaneous and visceral forms, the latter usually being fatal if untreated. Leishmaniasis is present in the Mediterranean area of Europe and North Africa, in Southern and Central America, in Africa - particularly the Horn of Africa - and in the Indian sub-continent and parts of South East Asia.
Co-infection with leishmaniasis and HIV is becoming more common as HIV spreads in leishmania-endemic areas. Co-infection in the Indian subcontinent and in sub-Saharan Africa where rates of HIV and leishmania infection are high are a matter of particular concern, however co-infection is a major problem in all areas where the two diseases co-exist. Co-infection creates particular difficulties in diagnosis and treatment of leishmaniasis and the prognosis of those who are co-infected are poor. Even where HIV viral load falls and CD4+ counts rise in patients treated with HAART, the treatment of leishmaniasis in the co-infected patient remains problematic and the long-term prognosis is poor. Because co-infected individuals have high relatively levels of the leishmania parasite in their blood the potential for anthroponotic transmission via sandflies is increased. Cases of anthroponotic transmission amongst injecting drug users in Europe have also been reported. Thus co-infection is likely to adversely affect the epidemiology of leishmaniasis and increase the potential for epidemic spread.
The workshop was intended to address two issues:
· To develop guidelines for the practical diagnosis and management of cases of leishmania/HIV co-infection.
· To provide training in VCT for HIV for clinicians working with leishmaniasis patients.