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· Leishmania/HIV co-infections can lead to epidemiological changes which modify the traditional patterns of zoonotic VL. Co-infected patients harbour a high number of Leishmania in their blood so there is also a risk of them becoming reservoirs of the disease (that is, infective for the sandfly vector) as in anthroponotic foci in Bangladesh, India, Nepal and East Africa. Consequently, there is an increased risk of future epidemics.· Experimentally, sandflies can be infected through a blood meal containing a very small quantity of blood from co-infected patients. The quantity may be less than the content of a needle. As 71.1% of co-infected patients in south-western Europe are intravenous drug users, transmission of Leishmania has occurred through the sharing of syringes in this population group.
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