For personal use. Only reproduce with permission from The Lancet Publishing Group. individuals could become life-long symptom-free carriers, only a very small group of immunocompetent people are likely to develop symptoms, usually curable with appropriate treatment. However, in people with HIV, fatal visceral leishmaniasis could develop. While highly active antiretroviral therapy (HAART), which helps maintain immunocompetency, has substan-tially lowered the current number of cases of leishmaniasis in this sub-population, co-infection rates are probably still high. “Rural drug rehabilitation centres could be focal points of sandfly leishmania transmission,” Alvar told TLID . “Sandflies normally live in rural areas, and if leishmania-infected drug users are in close contact with HIV-infected people out in the country, co-infections could occur.” Adrian Burton THE LANCET Infectious Diseases Vol 1 August 2001 4 In southern Europe, the endemic and potentially fatal protozoal disease of leishmaniasis is usually transmitted from its canine reservoir to man by the bite of the sandfly Phlebotomus perniciosus. Now, Spanish scientists have shown that the pathogen may also be spread between intravenous drug users who share needles. Jorge Alvar, Director of the Tropical Diseases Research Unit, Carlos III Institute, Madrid, told TLID that in Spain over one half of drug users’ needles may contain the
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