Patients co-infected with HIV and tegumentary leishmaniasis (the term used in South America to denote CL, MCL, or DCL) were shown to have decreased absolute numbers of effector and central memory CD4 cells with decreased function as demonstrated by response to stimulation with Leishmania antigen [32]; however, this defect is not as profound as in HIV-VL co-infections (>350 and <200 CD4 cells/mm3, for tegumentary and visceral leishmaniasis, respectively) [33]. This evidence concerns the gene CD4 and visceral leishmaniasis.