Leprosy and Human Immunodeficiency Virus Infection

Abstract

A 35-year-old woman visited our venereal disease outpatient clinic to be tested for HIV infection. Sbe bad been working as a prostitute on tbe Soutb American mainland, tbe Caribbean, and in New York City. Sbe bad never used intravenous drugs. Her medical bistory revealed tbat sbe had a hepatitis B infection in 1978 and primary syphilis in 1984 for wbich she had been treated. Besides general symptoms of weight loss and anorexia, she had recently developed an anesthetic skin lesion on her right upper arm.Upon dermatologic examination, a hypopigmented macule of 6-7 cm in diameter with a minimal elevated slightly erythematous border was observed on her right upper arm. The sensitivity to light touch in tbe center of this lesion was clearly diminished as compared to tbat of the surrounding skin. A small hypopigmented macule with normal sensation was also seen on tbe abdomen. Peripheral nerves were not enlarged and there were no signs of peripheral neuropathy.Clinically, the lesions were compatible witb borderline tuberculoid-mid borderline (BT/BB) leprosy. Histologic examination of the biopsy specimens taken from the lesion on the upper arm showed perivascular and perineural lymphohistiocytic infiltrations with a tendency to granuloma formation. In and around the granuloma a mild extracellular edema was seen. Some of the histiocytes bad foamy cytoplasm and in a Wade-Fite's stained preparation contained solid staining acid-fast bacteria. The same histologic features, but with markedly less lymphocytic infiltrate, were observed in tbe specimen from the lesion of the abdomen. Tbe bistopathology was that of a borderline lepromatous (BL) leprosy in reaction. Immunobistochemical studies of the biopsy specimens showed that HLA-Dr was not expressed on the keratinocytes in the epidermis. There was a decrease in the number of Langerhans cells in tbe epidermis. The granulomas consisted of 75% T lymphocytes (CD3-I-cells) and 25% histiocytes. The lympbocytic infiltrate consisted of 50% CD4-f and 30 to 40% CD8-I-cells. No interleukin-2 (IL-2) receptor positive cells or natural killer (NK) cells were present in the infiltrate.

Human Immunodeficiency Virus Type 1 (Hiv-1) and Mycobacterium Leprae Co-Infection: Hiv-1 Subtypes and Clinical, Immunologic, and Histopathologic Profiles in a Brazilian Cohort

“…3,[8][9][10][11][12] Our results corroborate earlier reports that the histoarchitecture and cell phenotypes within the leprosy skin lesions are not changed by HIV. 11,34,35 The microanatomy of leprosy skin lesions in patients co-infected with HIV did not differ from the classic histomorphologic spectrum of leprosy. The identification of CD4+ cells, which was not feasible using antibodies to CD4 cells from two different suppliers on deparaffinized lesions, may provide important information about local immune response to M. leprae in dually infected patients.…”

Leprosy Reversal Reaction as Immune Reconstitution Inflammatory Syndrome in Patients with AIDS

“…In spite of blood CD4 + lymphocyte depletion in HIV-infected patients, there has been a previous report of skin biopsy of a leprosy lesion in HIV-infected patient in which half of the lesional cells were CD4 + [20]. Another study analyzed the histologic features of 12 HIV-M. leprae-coinfected patients and found a predominance of CD4 + lymphocytes, with few CD8 + lymphocytes in the infiltrate [21]; this is consistent with the immunohistochemical findings for the patients we describe.…”

Human Immunodeficiency Virus and Leprosy

“…The first II propositions listed above will be briefly discussed here; the last 3 have been considered elsewhere. [8][9][10] The studies presented to date on propositions 1-7 are either case reports [11][12][13][14][15][16] or cross sectional surveys, usually ofleprosy patients,4,1 7-26 and rarely of patients with AIDS , 27 A few contain longitudinal data on clinical developmentll, 14 That HIV and M. /eprae infections each might reciprocally increase the probability of later infection with the other is, on theoretical grounds, unlikely. For example, unlike many sexually transmitted diseases, leprosy seldom causes genital ulcer and is rarely, if ever, transmitted by sexual contact.…”