Roger Paredes

Herein we review the particular aspects of leishmaniasis associated with HIV infection. The data in this review are mainly from papers identified from PubMed searches and from papers in reference lists of reviewed articles and from the authors' personal archives. Epidemiological data of HIV/Leishmania co-infection is discussed, with special focus on the influence of Highly Active Antiretroviral Therapy (HAART) on incidence of leishmaniasis and transmission modalities. Microbiological characteristics, pathogenesis, clinical presentation and specific treatment of the co-infection are also presented.

AN APPROPRIATE comprehension of the factors that affect the virological response to antiretroviral treatments is warranted to improve the clinical treatment of human immunodeficiency virus (HIV)–infected patients. It is important, as well, to expand the rational basis for the accurate design of effective therapies and to reduce the duration and complexity of clinical trials. Formerly, the natural history of HIV infection was invariably unidirectional, progressively leading to acquired immunodeficiency syndrome (AIDS) and death, and the efficacy of therapy was determined by its ability to delay this fatal progression. Therefore, predictors of clinical progression have been extensively studied and precisely determined in HIV-infected patients.^1-8 Today, the clinical prognosis of HIV infection has radically changed because of the widespread use of highly active antiretroviral therapy (HAART), including protease inhibitors (PIs).^9-11 Partly because these studies link plasma HIV-1 RNA levels with risk of clinical progression, the positivist goal of antiretroviral therapy is now to reduce and maintain HIV-1 RNA levels below the lowest detectable.¹²