Leprosy and HIV coinfection: a critical approach

Massone, Cesare; Talhari, Carolina; Ribeiro‐Rodrigues, Rodrigo; Sindeaux, Renata H.M.; Mira, Marcelo Távora; Talhari, Sinésio; Naafs, Bernard

doi:10.1586/eri.11.44

Cited by 35 publications

(37 citation statements)

References 59 publications

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“…It is stated that cellular immunity towards Mycobacterium leprae infection remains intact in spite of the low CD4 count. 15 One patient developed type 1 reaction within six months of starting HAART and we believe this to be a manifestation of IRIS following HAART which has been described earlier. 16 The most commonly observed viral infection among the HIV patients was herpes zoster which is in accordance with certain previous studies.…”

Section: Discussionsupporting

confidence: 64%

Mucocutaneous infections in HIV positive patients attending a tertiary care institution: a descriptive study

2017

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Background: AIDS is characterized by the waning of body’s immunity leaving the victim to the multitude of life threatening opportunistic infections, neurological disorders or malignancies. Dermatologic manifestations occur in more than 90% of patients with HIV infection most often due to infections. The awareness of the varied patterns of these skin lesions would help in early diagnosis and management of these in HIV infection, which in turn reduce the morbidity and improve quality of life.Methods: Observational study from 1st April 2012 to 31st March 2013 in a tertiary care institution of North Kerala. HIV positive patients attending sexually transmitted infection clinic of Dermato venereology department, anti-retroviral treatment clinic (ART clinic) and infectious diseases ward of Department of Medicine of a tertiary care centre were examined after consent for mucocutaneous infections. Results: The study population comprised of 206 HIV infected patients with mucocutaneous infections. The male to female ratio was 2.07:1. Most of the affected belong to 30-50 years age group. Majority were manual laborers(49.3%) and in stage3 HIV disease. 107 patients had CD4 Count below 350 at the time of study(51.9%) whereas 40 cases (19.4%) had CD4Count above 500. Most common mucocutaneous infection was oral candidiasis (51%), followed by onychomycosis (16.5%). Out of 29 patients with dermatophytosis majority had tinea cruris (18 patients). Bacterial was second commonest infection. Only 3 patients had tuberculoid leprosy, one with type 1 reaction. Common viral infection was herpes zoster followed by herpes genitalis and conyloma accuminata. 11 patients had verruca vulgaris, one with extensive lesions. Out of 206 patients 28 had sexually transmitted infections (STIs) other than HIV, herpes genitalis being the commonest. Syphilis observed in 4 patients (1.9%). 162 patients (78.6%) were on HAART. The response to treatment was better in patients with CD4 Count above 500cells/mm3. Conclusions:Oral candidiasis, onychomycosis, pyoderma and ulcerative STIs were noted in significant number of HIV infected individuals. These were more common in those with CD4Count below 300 cells/ mm3. .Those patients with CD4 Count above 500 cells/ mm3 responded well to treatment.

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Section: Discussionsupporting

confidence: 64%

Mucocutaneous infections in HIV positive patients attending a tertiary care institution: a descriptive study

2017

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“…Considering the same IRIS criteria previously used by our group to define IRIS cases [13], 93 out of 9 IRIS/RR patients (Hs012, Hs024 and Hs043) can be really defined as IRIS cases, since they developed the symptoms during the first 6 months of HAART . However, others studies also identified IRIS cases at periods of longer than 10 months [30]. In this study, we aimed to characterize some of the key T cell phenotypes involved in the HIV/leprosy interaction in coinfected vs. non-coinfected patients and analyze some major features of the IRIS/RR phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cellular Phenotypes Implicated in Immunopathogenesis and Monitoring Immune Reconstitution Inflammatory Syndrome in HIV/Leprosy Cases

et al. 2011

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BackgroundIt is now evident that HAART-associated immunological improvement often leads to a variety of new clinical manifestations, collectively termed immune reconstitution inflammatory syndrome, or IRIS. This phenomenon has already been described in cases of HIV coinfection with Mycobacterium leprae, most of them belonging to the tuberculoid spectrum of leprosy disease, as observed in leprosy reversal reaction (RR). However, the events related to the pathogenesis of this association need to be clarified. This study investigated the immunological profile of HIV/leprosy patients, with special attention to the cellular activation status, to better understand the mechanisms related to IRIS/RR immunopathogenesis, identifying any potential biomarkers for IRIS/RR intercurrence.Methods/Principal FindingsEighty-five individuals were assessed in this study: HIV/leprosy and HIV-monoinfected patients, grouped according to HIV-viral load levels, leprosy patients without HIV coinfection, and healthy controls. Phenotypes were evaluated by flow cytometry for T cell subsets and immune differentiation/activation markers. As expected, absolute counts of the CD4+ and CD8+ T cells from the HIV-infected individuals changed in relation to those of the leprosy patients and controls. However, there were no significant differences among the groups, whether in the expression of cellular differentiation phenotypes or cellular activation, as reflected by the expression of CD38 and HLA-DR. Six HIV/leprosy patients identified as IRIS/RR were analyzed during IRIS/RR episodes and after prednisone treatment. These patients presented high cellular activation levels regarding the expression of CD38 in CD8+ cells T during IRIS/RR (median: 77,15%), dropping significantly (p<0,05) during post-IRIS/RR moments (median: 29,7%). Furthermore, an increase of cellular activation seems to occur prior to IRIS/RR.Conclusion/SignificanceThese data suggest CD38 expression in CD8+ T cells interesting tool identifying HIV/leprosy individuals at risk for IRIS/RR. So, a comparative investigation to leprosy patients at RR should be conducted.

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“…This is contrary to current WHO views, which state that there is no association between leprosy and HIV. Immune reconstitution inflammatory syndrome (IRIS) has been reported where leprosy has been unmasked in patients on antiretroviral treatment (Massone et al. 2011; Rao et al.…”

Section: Discussionmentioning

confidence: 99%