Authors' reply.

Sir,

We thank Chhabra P for their comments.[1] The HIV test in our patient returned negative (HIV tests during pregnancy were also negative). It has also been reported HLH in AIDS is secondary not to the virus itself, but to overwhelming infections (particularly Pneumocystis jiroveci and nontuberculous mycobacteria). Complex immune mechanisms in HIV-Leishmania have been reported elsewhere.[2] In our country comparison between different microbiological techniques has been reported. However, serology is neither sensitive nor specific in the general Spanish population[3] and in HIV patients.[4] Our data on file in a pediatric cohort of HLH-Leishmania patients shows that only 32% of patients had a positive urine test. Thus, in our country the most reliable test remains PCR in bone marrow samples, followed by PCR in peripheral blood.