First report on Leishmania major/HIV coinfection in a Sudanese patient.

Leishmania/HIV coinfection is a new clinical form of leishmaniasis that has been reported in more than 35 countries [1,2]. The World Health Organization (WHO) estimates that 39.5 million people are infected by HIV worldwide and that one-third of them live in Leishmania-endemic regions [1,2]. Most of the reported Leishmania/ HIV coinfections were among patients infected with viscerotropic parasites, but few data are available on L. major/ HIV coinfection [2]. Coinfection of HIV patients with Leishmania spp. can occur naturally through infected vectors or artificially among intravenous drug users and recipients of blood transfusion. The coinfection modulates the severity of the clinical presentation of leishmaniasis and interferes with proper diagnosis. Leishmania/HIV coinfection of patients can result in the emergence of diverse Leishmania parasite clones; suppresses the host immune response; and increases blood parasitaemia, hence enhancing transmission. The coinfection also reduces the response of patients to antileishmanial drugs [3]. Cutaneous leishmaniasis is a neglected clinical form of leishmaniasis in Sudan. It is endemic in the north, central and western regions of the country. Cutaneous leishmaniasis in Sudan is thought to be caused by Leishmania major and transmitted by Phlebotomus papatasi. Recently L. donovani has been identified as a cause of cutaneous leishmaniasis in Sudan, although the vector has not yet been identified [4]. HIV is a growing health problem in Sudan with an increasing prevalence in most regions of the country. In this manuscript we report the first patient diagnosed with L. major/HIV coinfection in Sudan.