An increased incidence of visceral leishmaniasis in patients infected with the human immunodeficiency virus (HIV) is observed in areas in which both infectious diseases are endemic. Intensive worldwide traveling has also resulted recently in an increasing number of leishmanial and HIV coinfections in nonendemic areas. We describe the clinical, light microscopic, and ultrastructural features of two cases of imported, HIV-related, visceral leishmaniasis involving the alimentary tract, including the esophagus, the stomach, the duodenum, the ileum, the colon, and the rectum. We also discuss the differentiation of leishmanial infections from other HIV-related gastrointestinal opportunistic infections.