A 37-year-old male from Georgia came to France in October 2012. He had HIV infection since 2006 inconstantly treated with HAART. Other medical conditions were adrenal insufficiency, cirrhosis due to chronic HCV, and treatment-controlled tuberculosis. VL was diagnosed in 2010 and treated in Georgia with meglumine antimoniate and L-AmB (doses and schedules unknown). In November 2012, he presented hepatosplenomegaly, lymphadenopathies, infiltrated cutaneous lesions, anemia, number of CD4 lymphocytes = 133/mm3, viral load < 50 copies/mL, and parasitemia of 6 Leishmania/ml. He received a course of L-AmB followed by maintenance therapy for 5 months (Fig 1B). In May 2013, he had weight loss, hepatosplenomegaly, anemia, number of CD4 lymphocytes = 177/mm3, viral load < 40 copies/mL and parasitemia of 12 Leishmania/ml. L-AmB treatment was intensified, but renal insufficiency and acute thrombocytopenia occurred. In June, the splenomegaly and parasitemia remained unchanged. A course of meglumine antimoniate was administered. Despite pre-existing liver disorders, the treatment was well tolerated except for mild neutropenia. One month later, a marked clinical improvement was observed and parasitemia decreased to 0.2 Leishmania/ml. In July, maintenance treatment with miltefosine (150 mg/day for 3 months) was started. Parasitemia was negative, the number of CD4 lymphocytes increased from 169 to 540/mm3, and viral load was undetectable. Parasitemia remained negative through 18 months.