Ultrasensitive Real-Time PCR for the Clinical Management of Visceral Leishmaniasis in HIV-Infected Patients

Israel Molina Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Roser Fisa Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Cristina Riera Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Vicenç Falcó Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Aleix Elizalde Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Fernando Salvador Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Manuel Crespo Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Adrian Curran Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Paulo López-Chejade Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Silvia Tebar Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Santiago Pérez-Hoyos Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Esteban Ribera Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Albert Pahissa Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain; Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain

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Molecular methods have been proposed as an alternative tool for the diagnosis of visceral leishmaniasis (VL), but no data are available regarding use for monitoring clinical outcome. A prospective cohort study of human immunodeficiency virus-(HIV) and VL-coinfected patients was conducted in a university-affiliated hospital in Barcelona, Spain. Leishmania parasite load was monitored using a real-time polymerase chain reaction (PCR) at baseline and every 3 months. Cutoff values for PCR were determined using receiver operating characteristic (ROC) curves. Overall, 37 episodes were analyzed, and 25 of these episodes were considered as relapsing episodes. A significant decrease of parasite load measured 3 months after treatment could predict the clinical evolution of VL. A parasite load over 0.9 parasites/mL measured 12 months after treatment could predicts relapse with a sensitivity of 100% and a specificity of 90.9%. Monitoring parasite load by an ultrasensitive quantitative Leishmania PCR is useful to predict the risk of relapse after a VL episode in HIV-infected patients.

Author Notes

* Address correspondence to Israel Molina, P° Vall d'Hebron 119, 08035 Barcelona, Spain. E-mail: imolina@vhebron.net

Financial support: This study was partially supported by Red Temática de Investigación en Síndrome de Inmunodeficiencia Adquirida (SIDA) (RIS G03/173-RETIC RD06/0006/0039).

Authors' addresses: Israel Molina, Vicenç Falcó, Aleix Elizalde, Fernando Salvador, Manuel Crespo, Adrian Curran, Esteban Ribera, and Albert Pahissa, Infectious Disease Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain, E-mails: imolina@vhebron.net, vfalco@vhebron.net, ealeix@hotmail.com, medinano@yahoo.es, mcrespo@vhebron.net, acurran@vhebron.net, eribera@vhebron.net, and apahissa@vhebron.net. Roser Fisa, Cristina Riera, Paulo López-Chejade, and Silvia Tebar, Parasitology Department, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain, E-mails: rfisa@ub.edu.es, mcriera@ub.edu.es, pllch@yahoo.com, and stebar@ub.edu.es. Santiago Pérez-Hoyos, Unit of Methodologic Support in Biomedical Research, Vall d'Hebron Research Institute, Spain, E-mail: santi.perezhoyos@vhir.org.

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