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The Leishmania/HIV co-infection has emerged as a result of the increasing overlap between the parasite (essentially L. donovani and L. infantum) and HIV in both rural and suburban areas. Cases of co-infection have so far been reported from 36 countries around the world, most of the cases have been notified in south-western Europe: over 1,911 in early 2001.
While the incidence of new clinical cases of VL in HIV co-infected individuals has dropped significantly in Europe over the past years, co-infection might further raise in several countries of Africa and Latin America. The risk of co-infected patients forming a source of infection for the sand fly or for other humans (f.e. through sharing syringes among intravenous drug users) has been confirmed. Co-infected patients might become reservoirs of L. donovani and L. infantum the causal agents of VL, especially in an urban context.
Apart from HIV, there are other immunosuppressive factors that might contribute to the spreading of leishmaniasis (like graft-associated treatments or concomitant diseases like tuberculosis).