Clinical and epidemiological aspects of coinfection with American tegumentary leishmaniasis and HIV/AIDS in South American countries: a systematic review.

Leishmaniasis is one of the 10 leading neglected tropical diseases (NTDs), and cutaneous leishmaniasis is endemic in 19 countries in the Americas. This study aimed to systematically review the epidemiological and clinical characteristics, diagnostic methods, and outcomes associated with coinfection with American tegumentary leishmaniasis (ATL) and HIV in South American countries. This review was registered in the International Prospective of Systematic Reviews (PROSPERO; CRD42023138800). Searches were conducted in the following electronic scientific databases: the Biblioteca Virtual em Saúde, Literatura Latino-americana e do Caribe em Ciências da Saúde, SciVerse Scopus, the US National Library of Medicine (PubMed) and Web of Science, using subject headings from the Descritores em Ciências da Saúde and Medical Subject Headings in Portuguese, English and Spanish for studies published from 1987 to 2025. Two independent reviewers performed study selection. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Overall, 417 participants from 32 studies were included in this systematic review. Argentina, Bolivia, Brazil, Colombia, Ecuador, Paraguay and Peru reported concurrent ATL and HIV. In 29 studies (90.6%), the diagnosis was established based solely on clinical criteria. Diagnostic methods for ATL included culture and the Montenegro skin test, whereas those for HIV included Enzyme-Linked Immunosorbent Assay, Western blotting, and indirect immunofluorescence. Approximately 68% of the analyzed data were derived from case reports, limiting the overall level of evidence. Strengthening integrated surveillance is needed to improve the clinical management of patients with ATL-HIV coinfection and expand access to health services.