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Background  Autochthonous cutaneous and visceral leishmaniasis (VL) caused by  Leishmania martiniquensis  and  Leishmania siamensis  have been considered emerging infectious diseases in Thailand. The disease burden is significantly underestimated, especially the prevalence of  Leishmania  infection among HIV-positive patients.    Methods  A cross-sectional study was conducted to determine the prevalence and risk factors associated with  Leishmania  infection among patients with HIV/AIDS living in Trang province, southern Thailand, between 2015 and 2016. Antibodies against  Leishmania  infection were assayed using the direct agglutination test (DAT). DNA of  Leishmania  was detected by ITS1-PCR using the buffy coat. Species of  Leishmania  were also identified.    Results  Of 724 participants, the prevalence of  Leishmania  infection was 25.1% (182/724) using either DAT or PCR assays. Seroprevalence of  Leishmania  infection was 18.5% (134/724), while  Leishmania  DNA detected by the PCR method was 8.4% (61/724). Of these, 24.9% (180/724) were asymptomatic, whereas 0.3% (2/724) were symptomatic VL and VL/CL (cutaneous leishmaniasis). At least five species were identified:  L. siamensis ,  L .  martiniquensis ,  L .  donovani  complex,  L .  lainsoni , and  L .  major . Multivariate analysis showed that CD4 +  levels <500 cells/μL and living in stilt houses were independently associated with  Leishmania  infection. Those who were PCR positive for  Leishmania  DNA were significantly associated with a detectable viral load, whereas non-injection drug use (NIDU) and CD4 +  levels <500 cells/μL were potential risk factors of  Leishmania  seropositivity.    Conclusions  A magnitude of the prevalence of underreporting  Leishmania  infection among Thai patients with HIV was revealed in this study. Effective public health policy to prevent and control disease transmission is urgently needed.

Prevalence and risk factors associated with Leishmania infection in Trang Province, southern Thailand