Visceral leishmaniasis & HIV co-infection in Bangladesh: Investigating prevalence and policy recommendations

Background: Human Immunodeficiency Virus (HIV) co-infection has emerged as a significant challenge in implementing the World Health Organization’s (WHO’s) strategic interventions to eliminate Visceral leishmaniasis (VL) in co-endemic countries. VL-HIV co-infection results in rapid deterioration, higher mortality, and substantially increases the risk of developing VL, facilitating parasite transmission. Although Bangladesh has received official validation for the elimination of VL as public health problem in 2023, determining the prevalence of VL-HIV co-infection became imperative to develop effective strategies to sustain the elimination status. Therefore, in this study, we aim to investigate the prevalence of HIV infection in the VL patients in Bangladesh.Methods: A total of 656 VL, post kala-azar dermal leishmaniasis (PKDL), and relapsed VL patients were enrolled and tested for HIV following national HIV testing guidelines. Furthermore, the knowledge and attitudes of 624 participants were assessed through one-to-one interviews using structured questionnaires.Findings: None of the patients tested positive for VL-HIV co-infection. Only 9.46% of respondents demonstrated comprehensive HIV/AIDS knowledge. However, 76.92% of respondents exhibited overall high knowledge, and 55.39% had positive attitudes towards individuals living with HIV/AIDS.Interpretation: The study reports no cases of HIV co-infection within the largest VL cohort in Bangladesh. However, considering the substantial health implications and increased HIV incidence in general population, we recommend routine HIV testing in all VL patients in Bangladesh, aligning with the WHO recommendations.