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Leishmania/HIV co-infection is emerging as an extremely serious, new disease and it is increasingly frequent. There are important clinical, diagnostic, chemotherapeutic, epidemiological and economic implications of this trend.
· Although people are often bitten by sandflies infected with Leishmania protozoa, most do not develop the disease. However, among persons who are immunosuppressed (e.g. as a result of advanced HIV infections, immunosuppressive treatment for organ transplants, haematological malignancy, auto-immune diseases), cases quickly evolve to a full clinical presentation of severe leishmaniasis.· AIDS and VL are locked in a vicious circle of mutual reinforcement. On the one hand, VL quickly accelerates the onset of AIDS (with opportunistic diseases such as tuberculosis or pneumonia) and shortens the life expectancy of HIV-infected people. On the other hand, HIV spurs the spread of VL. AIDS increases the risk of VL by 100-1000 times in endemic areas.
· This duo of diseases produces cumulative deficiency of the immune response since Leishmania parasites and HIV destroy the same cells, exponentially increasing disease severity and consequences. VL is considered a major contributor to a fatal outcome in co-infected patients. Lately, however, use of tritherapy, where it is available, has improved the prognosis for Leishmania/HIV cases.
· Leishmaniasis can be transmitted directly person to person through the sharing of needles, as is often the case among intravenous drug users. This group is the main population at risk for co-infection.
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