Assessment of Asymptomatic Leishmania Infection in People Living With HIV: A Long-term Follow-up Study in Northeastern Brazil

Matheus Henrique Gonçalves Aguiar^1*Diego Guedes^1,2Walter Lins Barbosa Júnior³Elis Dionisio da Silva^3,4Gilberto Silva Nunes Bezerra^5*Cristine Bonfim⁶Amanda Virginia Batista Vieira⁷Bruna Eduarda Freitas Monteiro⁴Roberta dos Santos Souza³Lucyo Flávio Bezerra Diniz⁸Samuel Ricarte De Aquino⁸Luiz Gustavo Mendes⁹Alda Maria Justo¹⁰Zulma Maria de Medeiros^1,3,4*

• ¹Postgraduate Program in Health Sciences, University of Pernambuco (Campus Santo Amaro), Recife, Brazil
• ²Department of Life Sciences, Federal University of Pernambuco, Caruaru, Brazil
• ³Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil
• ⁴Graduate Program in Health Biosciences and Biotechnology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil
• ⁵Department of Pharmaceutical Science and Biotechnology, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
• ⁶Social Research Division, Joaquim Nabuco Foundation, Ministry of Education, Recife, Brazil
• ⁷Postgraduate Program in Health Sciences, University of Pernambuco (Campus Santo Amaro),, Recife, Brazil
• ⁸Hospital Universitario da Universidade Federal do Vale do Sao Francisco, Petrolina, Brazil
• ⁹Ministry Health, Petrolina, Brazil
• ¹⁰Universidade de Pernambuco - Campus Petrolina, Petrolina, Brazil

Word count: 214 In people living with HIV (PLWH), surveillance for Leishmania infection is crucial for identify those at risk of developing visceral leishmaniasis (VL). Leishmania-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 Leishmania-HIV coinfected outpatients and Leishmania-negative PLWH. Participants were drawn from a cross-sectional study performed in 2017, which identified both Leishmania-HIV coinfected and Leishmania-negative PLWH. Epidemiological, clinical, and laboratory data were collected from medical records (2017–2023). In 2023, these individuals were retested for Leishmania 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; p = 0.023). Three patients experienced relapse: one from the PLWH group and two from the coinfected group. There was one death in the Leishmania-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 Leishmania-HIV patients to mitigate disease progression and associated complications.