HIV-induced immunosuppression increases the risk of contracting VL 100–1000 times. Most cases of HIV–VL co-infection have been reported from Spain, France, Italy and Portugal. Antiretroviral therapy (ART) has led to a remarkable decline in the incidence of VL co-infection in Europe. However, numbers are increasing in Africa (mainly Ethiopia), Brazil and in the Indian subcontinent.

Although the clinical triad of fever, splenomegaly and hepatomegaly is found in the majority of co-infected patients, those with low CD4 count may have atypical clinical presentations, posing a diagnostic challenge. VL may present with gastrointestinal involvement (stomach, duodenum or colon), ascites, pleural or pericardial effusion, or involvement of lungs, tonsil, oral mucosa or skin. Diagnostic principles remain the same as those in non-HIV patients. Parasites are numerous and easily demonstrable, even in buffy coat preparations. Sometimes amastigotes are found in unusual sites, such as bronchoalveolar lavage fluid, pleural fluid or biopsies of the gastrointestinal tract. Immunofluorescence, Western blot, ELISA and other serological tests used singly have low sensitivity. DNA detection by PCR of the blood or its buffy coat are at least 95% sensitive, and accurately track recovery and relapse.


The medicines that can be thought of use are:-

  • Pyrogenium
  • Ars iod
  • Arsenic
  • Spigelia
  • Secale cor