We describe the case of an adult HIV+ patient presenting an unusual form of VL in our reference center, in Valle del Cauca, Colombia.A 42-year-old HIV-positive male, receiving HAART with an undetectable viral load and persistent CD4+ T-cell count of 15mm3, consulted in April 2011 with a 2 year history of an abdominal mass, associated pain, intermittent diarrhea, subjective weight loss, and no fever.On physical examination abdomen was distended, tender to palpation with grade III splenomegaly and mild hepatomegaly.CT scan showed hepatosplenomegaly with mesenteric and retroperitoneal lymph nodes.The patient had lived in Spain for 6 years, where in October 2009 he presented high-titer serology for leishmaniasis.He later returned to Colombia where bone marrow aspiration was performed in December 2010 with results suggestive of leishmaniasis.Antileishmanial treatment was not prescribed.Upon consultation in 2011, the patient was hospitalized for confirmatory bone marrow aspiration and biopsy, which demonstrated dissemination of Leishmania spp.infection.Amphotericin-B deoxycolate was started, but due to creatinine elevation was changed to AmBisome®, for a total of 30 days treatment with substantial improvement in abdominal pain and diarrhea, weight gain of 7 kg, undetectable viral load and increased CD4+ T-cell count of 54mm.An empirical secondary prophylaxis regime was started with AmBisome® 200 mg/weekly.In endemic regions for visceral leishmaniasis, coinfection is common in HIV patients with CD4-count less than 200cel/mm3.Clinical response and HAART are closely related, with a high mortality if HIV remains untreated.Due to nonspecific and chronic symptoms in this case, diagnosis was challenging, demonstrating that visceral leishmaniasis should be considered as a differential diagnosis in inmunocompromised patients in Colombia.Secondary prophylaxis is not included in Colombian guidelines, and scientific literature reports 50% recurrence with amphotericin-B using a 21-day scheme.Weekly AmBisome® prophylaxis administered in this case has been used successfully in other infectious diseases.