Recent reports from animal models and from cross-sectional studies have suggested that host responses to anti-Lutzomyia longipalpis saliva antibodies may be related to delayed-type hypersensitivity to Leishmania antigen. In a prospective cohort study, we evaluated 1,080 children from two endemic areas for visceral leishmaniasis (VL) by means of Kaplan-Meier analysis. The incidence rate of delayed-type hypersensitivity to Leishmania antigen, measured at the 24th follow-up month, was higher among those reactive to Lu. longipalpis saliva antibodies at the beginning of the study (0.0217 cases per person-month) than among those previously negative (0.0131 cases per person-month) (P value for the log-rank test = 0.0006). It seems that mounting an anti-saliva immune response helps the development of a cell-mediated anti-Leishmania response.