 |
| ||||||||||||||||||||||||||||||||||||
Cases of Leishmania/HIV co-infections are being reported more frequently in various parts of the world. It is anticipated that the number of Leishmania/HIV co-infections will continue to rise in the coming years and there are indications that cases are no longer restricted to endemic areas.
The overlapping geographical distribution of VL and AIDS is
increasing due to two main factors: the spread of the AIDS pandemic in suburban
and rural areas of the world, and the simultaneous spread of VL from rural to
suburban areas.
· Leishmania/HIV co-infections are considered a real threat, especially in south-western Europe. Of the first 1 700 cases of co-infection which have been reported to the World Health Organization (WHO) from 33 countries worldwide up to 1998, 1 440 cases were from the region: Spain (835); Italy (229); France (259); and Portugal (117). Of 965 cases retrospectively analyzed, 83.2% were males, 85.7% were young adults (20-40 years old) and 71.1% were intravenous drug users.· Most co-infections in the Americas are reported in Brazil, where the incidence of AIDS has risen from 0.8 cases per 100 000 inhabitants in 1986 to 10.5 cases per 100 000 inhabitants in 1997. As HIV transmission has spread into rural areas, VL has simultaneously become more urbanized - especially in north-eastern Brazil - increasing the risk of overlapping infection.
· The number of cases of Leishmania/HIV co-infection is expected to rise in Africa owing to the simultaneous spread of the two infectious diseases and their increasingly overlapping geographical distribution, complicated by mass migration, displacement, civil unrest, and war.
· In general, the reported cases of Leishmania/HIV co-infection in Africa are a very modest estimation and would substantially increase if active surveillance were implemented throughout the continent. Ethiopia has a well-organized system of detection, management and reporting of co-infection. Kenya and Sudan began surveillance in 1998 and Morocco has also established a surveillance centre.
· In East Africa, cases of Leishmania/HIV co-infections have been reported in Djibouti (10), Ethiopia (74), Kenya (15), Malawi (1) and Sudan (3). West Africa has no official surveillance system yet, but several cases have been reported: Cameroon (1), Guinea Bissau (1), Mali (4) and Senegal (2). In North Africa, cases have been reported in Algeria (20) and Morocco (4).*
*Figures from countries without surveillance systems are based upon random reports only. To properly assess the scale of the problem, there is an urgent need for more accurate information based on specific studies
 |
 |
