Tendência temporal e perfil clínico-epidemiológico da coinfecção por leishmaniose visceral e HIV em estados brasileiros entre 2009 e 2024

This study aimed to analyze temporal trends and the clinical-epidemiological profile of visceral leishmaniasis (VL)-HIV coinfection in Brazil between 2009 and 2024. This ecological time-series and descriptive cross-sectional study used data from the Brazilian Information System for Notifiable Diseases (SINAN, acronym in Portuguese) covering eight states with the highest VL incidence: Bahia, Ceará, Maranhão, Minas Gerais, Mato Grosso do Sul, Pará, São Paulo, and Tocantins. Annual coinfection rates were calculated as the ratio between the number of reported VL-HIV coinfection cases and the resident population of the respective state in the same year, multiplied by 100,000. Temporal trends were evaluated using segmented regression to estimate the annual percentage change (APC). Correlation analyses (Spearman), categorical associations (Pearson's chi-squared test), differences in means (Student's t-test), and binary logistic regression (odds ratio - OR) for symptoms were also performed. An increasing trend in coinfection rates was observed in Bahia (APC = 4.2), Mato Grosso do Sul (APC = 19.7), Pará (APC = 10.4), and Tocantins (APC = 8.4). Ceará and Minas Gerais showed an initial increase followed by a decline. A moderate positive correlation was observed between VL cases and coinfection (ρ = 0.313; p < 0.001). Coinfected individuals had a higher mean age (37.9 versus 27.3 years; p < 0.001) and were predominantly male (72.4% versus 59.8%). Mixed-race individuals were the most prevalent, with a higher proportion of Black individuals among coinfected patients. Symptoms associated with coinfection included fever (OR = 2.44), jaundice (OR = 1.69), and edema (OR = 1.56), whereas weight loss, hepatomegaly, and associated infection were associated with lower odds. VL-HIV coinfection shows heterogeneous patterns, with increasing trends in endemic states and distinct temporal segments across Federative Units. These findings reinforce the need for integrated strategies for surveillance, diagnosis, and treatment.