Leishmaniasis as a manifestation of immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients: A literature review

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/mm(3) 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.

• Population(s)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Other