title: Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients: A Literature Review.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Universidade Federal da Bahia, Complexo Hospitalar Prof Edgard Santos, Unidade docente de Infectologia, Salvador, BA, Brazil rbadaro884@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Badaró
authors.affiliation: Universidade Federal da Bahia, Complexo Hospitalar Prof Edgard Santos, Unidade docente de Infectologia, Salvador, BA, Brazil.
authors.forename: Larissa O
authors.initials: LO
authors.lastname: Gonçalves
authors.affiliation: Fundação Oswaldo Cruz, Centro de Pesquisa Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brazil Escola Bahiana de Medicina e Saúde Pública, Faculdade de Medicina, Salvador, BA, Brazil.
authors.forename: Luana L
authors.initials: LL
authors.lastname: Gois
authors.affiliation: Universidade Federal da Bahia, Complexo Hospitalar Prof Edgard Santos, Unidade docente de Infectologia, Salvador, BA, Brazil.
authors.forename: Zuinara Pereira Gusmão
authors.initials: ZP
authors.lastname: Maia
authors.affiliation: University of California San Diego, Division of Infectious Diseases, La Jolla, CA, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Benson
authors.affiliation: Fundação Oswaldo Cruz, Centro de Pesquisa Gonçalo Moniz, Laboratório Avançado de Saúde Pública, Salvador, BA, Brazil Escola Bahiana de Medicina e Saúde Pública, Faculdade de Medicina, Salvador, BA, Brazil.
authors.forename: Maria Fernanda Rios
authors.initials: MF
authors.lastname: Grassi
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000469:parasitology* / Q000821:virology; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000469:parasitology*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology / Q000469:parasitology* / Q000821:virology; D007896:Leishmaniasis / Q000276:immunology* / Q000821:virology; D008297:Male; D008875:Middle Aged
keywords: HIV/AIDS; IRIS; co-infection HIV/Leishmania; immune reconstitution inflammatory syndrome; leishmaniasis