Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients: A Literature Review

J Int Assoc Provid AIDS Care. 2015 Sep-Oct;14(5):402-7. doi: 10.1177/2325957414555225. Epub 2014 Oct 20.


Introduction: After the onset of highly active antiretroviral therapy (HAART), some HIV-infected patients present a severe inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary and visceral leishmaniasis have been described in association with IRIS.

Methods: A systematic literature review of IRIS in association with leishmaniasis identified 34 reported cases.

Results and discussion: The majority of these occurred in males 4 months following the onset of HAART. The mean CD4 count before HAART was 94 ± 77 cells/mm³ increasing to 5 times the initial value between the onset of HAART and IRIS presentation. Visceral leishmaniasis and post-kala-azar dermal leishmaniasis were the most commonly reported clinical manifestations, followed by tegumentary leishmaniasis and uveitis.

Conclusions: Commonly found characteristics included cutaneous involvement, regardless of Leishmania species; appearance of lesions unrelated to time of probable Leishmania infection; rapid recovery of CD4 count following HAART; and rapid progression.

Keywords: HIV/AIDS; IRIS; co-infection HIV/Leishmania; immune reconstitution inflammatory syndrome; leishmaniasis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / parasitology*
  • AIDS-Related Opportunistic Infections / virology
  • Adult
  • Female
  • HIV Infections / immunology
  • HIV Infections / parasitology*
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / immunology
  • Immune Reconstitution Inflammatory Syndrome / parasitology*
  • Immune Reconstitution Inflammatory Syndrome / virology
  • Leishmaniasis / immunology*
  • Leishmaniasis / virology
  • Male
  • Middle Aged