No abstract

indicates that about 2540 men in the sentenced prison population injected drugs in the six months before arrest.45 If we assume from our data that 8% of them were HIV positive that gives an estimated total of 203 HIV Patients, methods, and results Eight consenting adults (seven men and one woman) with lepromatous leprosy (five patients) or borderline lepromatous leprosy (three) who had been previously untreated (six) or whose leprosy had relapsed (two) were treated with 100 mg minocycline alone once daily for three months.After one week's treatment we observed improvement in either skin erythema or induration in six patients and improvement in both manifestations in two. After three months' treatment skin lesions had noticeably improved in all patients, six patients having complete resolution of all erythema and induration. One patient had mild transient vertigo, which resolved spontaneously without discontinuing treatment. No other adverse reaction was noted. Unexpectedly, none of the patients developed a lepra reaction.Before treatment and at one week and one, two, and three months after starting treatment skin biopsies were performed, from which 5 x 103 M leprae were inoculated into the hind feet of BALB/c mice. If more than 10' acid fast bacilli per foot pad were found in pooled foot pads (four) harvested eight and 12 months subsequently or in one foot pad or more of those (generally 10) counted individually 12 months after infection, viable bacilli were considered to have been present in the inoculum.All of the pretreatment skin biopsy specimens consistently resulted in growth of the bacilli in mice when evaluated by both methods. According to the findings of pooled harvests of foot pads no patient harboured any viable M leprae at either two or three months after starting treatment (table). Harvests of individual foot pads were more sensitive in detecting any viable M leprae; in six instances these results were positive and those of pooled harvests were negative, and in none was the opposite true (table). Viable bacilli were consistently absent from the skin in only one patient at one week after treatment. At one and two months respectively three and six of the patients had lost detectable viable leprosy bacilli, and by three months none of the eight patients harboured any viable bacilli.Serum minocycline concentrations determined by an agar disc diffusion method2 were at the peak (two hours after treatment) 1 84 (SD 0 48) mg/l (range 1 07-2-66 mg/i) and at the trough (24 hours after treatment) 0-43 (0 11) mg/l (range 0 33-0 58 mg/i), well above that (0-17 mg/i) previously found to inhibit consistently growth ofM leprae in mice.23 CommentThe consistent rapidity of the patients' clinical response to minocycline is unique in our experience. The clearance of viable M leprae from the skin by minocycline was faster than that reported for dapsone or clofazimine,4 slower than that for rifampicin,' and similar to that for pefloxacin and ofloxacin.5Hansen's Disease Research Program,

Haemolysis and frank anaemia from dapsone therapy of leprosy has been long recognized. However, the frequency and severity of this side-effect have not been well documented. We report herein a retrospective analysis of the effect of daily dapsone (generally 100 mg/day) on the haemoglobin concentration of 100. leprosy patients undergoing initial chemotherapy. The average haemoglobin was fo und to fall significantly by almost 2 g/dl, from 14•25 ± 1•27 g/dl to a nadir of 12•31 ± 1•61 (P < 0•00 I). Eighty-three percent of patients had a fa ll of haemoglo bin concentration of I g/dl or more, while in 16% of patients the haemoglobin fe ll � 3 g/dl. Increasing age was fo und associated with an increased magnitude of dapsone-related haemolysis (P � 0'004). Decreasing the daily dose of dapsone was associated with an increased haemoglobin concentration (P < 0•00 1 %). We have concluded that dapsone commonly results in not only haemolysis but a significant decrease in haemoglobin concentration. This may have serious clinical implica tions, especially in endemic areas, where, owing to nutrition, malaria, and intestinal parasitism, the haemoglobin concentration is already compromised.