Risk Factors of Leishmania Infection among HIV-Infected Patients in Trang Province, Southern Thailand: A Study on Three Prevalent Species

Abstract

There are two main species of <i>Leishmania</i> reported in Thailand, that is, <i>Leishmania siamensis</i> and <i>Leishmania martiniquensis.</i> Moreover, leishmaniasis cases caused by <i>Leishmania donovani</i> complex were also reported. There is still a lack of information concerning risk factors of <i>Leishmania</i> infection in Thailand. This study aimed to identify the risk factors of <i>Leishmania</i> infection caused by these three species among HIV-infected patients. A cross-sectional study was conducted in HIV clinic at Trang Hospital, Thailand. Nested PCR and sequencing were performed to detect <i>Leishmania</i> DNA in blood and saliva samples and identify <i>Leishmania</i> species. A standardized questionnaire was used to interview individuals. A total of 526 patients were recruited in this study. Sixty-three (12.0%) were positive for <i>L. siamensis</i>, 24 (4.6%) were positive for <i>L. martiniquensis</i>, and 23 (4.4%) were positive for <i>L. donovani</i> complex. Risk factors of <i>L. siamensis</i> infection included using intravenous drug (adjusted odds ratio [AOR] 2.01, 95% CI: 1.01-4.02). Risk factors of <i>L. martiniquensis</i> infection included female gender (AOR 4.23, 95% CI: 1.52-11.75), using recreational drug (AOR 3.43, 95% CI: 1.00-11.74), and having comorbidities (AOR 4.94, 95% CI: 2.00-12.21). Risk factors of <i>L. donovani</i> complex infection included having opportunistic infection (AOR 4.22, 95% CI: 1.00-17.79), CD4 count 200-500 cells/mm³ (AOR 3.64, 95% CI: 1.14-6.86), and not using insect repellent (AOR 3.04, 95% CI: 1.08-8.58). This study identified the risk factors of <i>Leishmania</i> infection caused by three <i>Leishmania</i> species in Thailand. The data could be useful for disease prevention and control. Further studies on trends of <i>Leishmania</i> infection and preventive measures are recommended.