Comparative study of cutaneous leishmaniasis in human immunodeficiency virus (HIV)-infected patients and non-HIV-infected patients in French Guiana

Background : Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients.

Objectives : To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV– patients with the forms of leishmaniasis commonly found in French Guiana.

Methods : A case–control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection.

Results : Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV–Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0·02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0·02) than did HIV– subjects. The CD4+ lymphocyte counts exceeded 200 mm¯³ in all HIV+ patients at the time of the diagnosis with leishmaniasis.

Conclusions : In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm¯³) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV– subjects.