INTRODUCTION: The association of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection is a concern worldwide, and this co-infection is linked to increased lethality. The Northeast is the region that mostly reports cases of VL in Brazil. The knowledge of risk factors associated with VL/HIV co-infection and its impact on lethality is extremely important. METHODS: The present study analyzed the epidemiologic features of cases with VL/HIV co-infection in the state of Pernambuco, Northeast of Brazil, from 2014 to 2018. RESULTS: There were 858 and 11,514 reported cases of VL and HIV infection, respectively. The average incidences of VL and HIV infection were 1.82 and 24.4/100,000 inhabitants, respectively. Of all reported cases of VL, 4.9% (42/858) also had HIV infection. There was an inverse spatial association between VL and HIV infection incidences. The lethality rates of VL, HIV infection, and co-infection were 9.9%, 26.1%, and 16.6%, respectively. Most of the patients were males and lived in urban areas. The cases of VL mostly occurred in children aged below 10 years, whereas the cases of HIV infection and VL/HIV co-infection were primarily observed in adults between 20 years and 39 years old. CONCLUSIONS: We defined the profile and areas with most cases of co-infection and found that the lethality of VL with co-infection increased in the current period. These findings contribute to applying efforts with a greater focus in these identified populations to prevent future deaths.