Made available in DSpace on 2014-12-17T14:13:34Z (GMT). No. of bitstreams: 1 ElianaLTN_TESE.pdf: 2435421 bytes, checksum: e2270899f92315394897270d5f3384f3 (MD5) Previous issue date: 2009-10-05 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Visceral leishmaniasis (VL) has undergone changes in terms of clinical and epidemiological presentation worldwide. Urbanization has been described in different regions of Brazil and the world, as well as in the state of Rio Grande do Norte. These changes have impacted in the clinical outcome of Leishmania infection. A new clinical entity called co-infection of HIV/Leishmania has been described as a consequence of overlapping areas of occurrence of VL and HIV / AIDS in different countries including Brazil. The aim of this study was to define the process of periurbanization of the LV and describe a case series of co-infection HIV / Leishmania in Rio Grande do Norte. A new demographic pattern of VL was detected, with an increase in the number VL adult male subjects. Analysis of spatial distribution of VL in the state of Rio Grande do Norte showed that in the past 20 years VL tends to occur in larger cities and therefore the highest risk disease is greater in the eastern and western regions. The first region included Natal, the state capital, where the process of suburbanization began in 1990, and more recently the city of Mossor?, the second largest state, where periurbanization began in the last five years. In 1990, the emergence of co-infection HIV/Leishmania in the state was observed. Case-control study revealed that the new clinical entity affects adult males, who acquired HIV through sexual intercourse, 40% of those with a preivous history of leishmania infection Relapse and death from LV is increased in HIV positive compared with HIV-negative patients matched by sex and age. This pattern is similar to the observed in Europe, except of the route of transmission, where in Europe occured concomitantly, by parenteral route in drug users. Analysis of spatial distribution identified overlapping new areas of occurrence of HIV / AIDS and LV potentially signaling to increased risk of this new clinical entity as described above. Therefore, epidemiological surveillance for co-infection HIV / Leishmania should be adopted in all areas of risk of VL. At the same time, it is necessary to evaluate drug resistance currently used in the treatment of VL, as well as parenteral transmission of L infantum/ chagasi in areas where drug dependence is a risk factor for HIV acquisition / Leishmaniose visceral (LV) vem sofrendo modifica??es do ponto de vista cl?nico e epidemiol?gico mundialmente. Urbaniza??o foi descrita em diferentes regi?es do Brasil e do mundo, como tamb?m no estado do Rio Grande do Norte, influenciando sobremaneira no comportamento cl?nico da doen?a. Uma nova entidade cl?nica denominada co-infec??o HIV/leishmania vem sendo descrita, como conseq??ncia da sobreposi??o de ?reas de ocorr?ncia de LV e HIV/AIDS, em diferentes pa?ses incluindo o Brasil. O objetivo deste estudo foi definir o processo de periurbaniza??o da LV e descrever s?rie de casos da co-infec??o HIV/Leishmania no Rio Grande do Norte. Mudan?a no padr?o demogr?fico da LV no RN foi detectada, sendo observado aumento no n?mero de indiv?duos na idade adulta, do sexo masculino. An?lise da distribui??o espacial demonstrou que nos ?ltimos 20 anos LV tende a instalar-se em munic?pios de maior porte e, portanto, mais urbanizados do RN, sendo as regi?es leste e oeste as de maior risco para a doen?a. A primeira regi?o inclui Natal, capital do estado, onde o processo de periurbaniza??o iniciou-se, em 1990 e, a outra, inclui a cidade de Mossor?, segunda maior do estado, onde a periurbaniza??o iniciou-se nos ?ltimos 5 anos. Tamb?m em 1990 registra-se a emerg?ncia da co-infec??o HIV/ Leishmania no estado. Estudo tipo caso-controle revelou que a nova entidade cl?nica acomete indiv?duos adultos do sexo masculino, que adquirem HIV por via sexual; 40% destes com hist?ria de infec??o pr?via por leishmania. Reca?das e ?bito por LV ? maior em pacientes HIV positivos comparados com pacientes HIV negativos, pareados por sexo e idade. Esse padr?o ? bastante semelhante ao europeu, exceto, pela via de transmiss?o, que ocorre l? de modo concomitante, por via parenteral, em usu?rios de drogas il?citas. Adicionalmente, a an?lise de distribui??o espacial identificou sobreposi??o de ?reas de ocorr?ncia de HIV/AIDS e LV no RN apontando para risco aumentado da nova entidade cl?nica descrita acima. Portanto, vigil?ncia epidemiol?gica para co-infec??o HIV/Leishmania deve ser adotada em todas as ?reas de risco. Ao mesmo tempo, faz-se necess?rio avaliar resist?ncia ?s drogas utilizadas atualmente, no tratamento da LV, bem como, transmiss?o parenteral de L infantum/chagasi, nas ?reas onde a depend?ncia de droga ? fator de risco para aquisi??o de HIV