SUMMARYHuman T-cell leukemia virus type 1 (HTLV-1), the first human retrovirus to be discovered, is present in diverse regions of the world, where its infection is usually neglected in health care settings and by public health authorities. Since it is usually asymptomatic in the beginning of the infection and disease typically manifests later in life, silent transmission occurs, which is associated with sexual relations, breastfeeding, and blood transfusions. There are no prospects of vaccines, and screening of blood banks and in prenatal care settings is not universal. Therefore, its transmission is active in many areas such as parts of Africa, South and Central America, the Caribbean region, Asia, and Melanesia. It causes serious diseases in humans, including adult T-cell leukemia/lymphoma (ATL) and an incapacitating neurological disease (HTLV-associated myelopathy/tropical spastic paraparesis [HAM/TSP]) besides other afflictions such as uveitis, rheumatic syndromes, and predisposition to helminthic and bacterial infections, among others. These diseases are not curable as yet, and current treatments as well as new perspectives are discussed in the present review.

Resumo A hanseníase é doença infecciosa crônica causada pelo Mycobacterium leprae. A predileção pela pele e nervos periféricos confere características peculiares a esta moléstia, tornando o seu diagnóstico simples. O Brasil continua sendo o segundo país em número de casos no mundo, após a Índia. Aproximadamente 94% dos casos conhecidos nas Américas e 94% dos novos diagnosticados são notificados pelo Brasil. A doença manifesta-se em dois pólos estáveis e opostos (virchowiano e tuberculóide) e dois grupos instáveis (indeterminado e dimorfo). Em outra classificação a doença é dividida em forma tuberculóide, borderline ou dimorfa que são subdivididos em dimorfa-tuberculóide, dimorfa-dimorfa e dimorfa-virchowiana, e virchowiana. A baciloscopia é o exame complementar mais útil no diagnóstico. O tratamento da hanseníase compreende: quimioterapia específica, supressão dos surtos reacionais, prevenção de incapacidades físicas, reabilitação física e psicossocial. A poliquimioterapia com rifampicina, dapsona e clofazimina revelou-se muito eficaz e a perspectiva de controle da doença no Brasil é real no curto prazo. Palavras-chaves: Hanseníase. Lepra. Micobacteriose. Mycobacterium leprae.Abstract Leprosy or Hansen's disease is a chronic infectious disease caused by the Mycobacterium leprae. The skin and nervous manifestations of the disease present a singular clinical picture that is easily recognized. After India, Brazil still is the second country with the greatest number of cases in the world. Around 94% of the known cases and 94% of the new cases reported in America, come from Brazil. The disease presents itself in two well-defined stable and opposite poles (lepromatous and tuberculoid) and two unstable groups (indeterminate and dimorphic). The spectrum of presentation of the disease may also be classified as: tuberculoid tuberculoid (TT), borderline tuberculoid (BT), borderline borderline (BB), borderline lepromatous (BL) and lepromatous lepromatous (LL). The finding of acid fast bacillus in tissue is the most useful method of diagnosis. The effective treatment of leprosy includes the use of specific therapy, suppression of lepra reactions, prevention of physical incapacity, and physical and psychosocial rehabilitation. Chemotherapy with rifampin, dapsone and clofazimine have produced very good results and the control of the disease in Brazil in the foreseeable future is likely. Key-words:Leprosy. Hansen's disease. Mycobacterium leprae. Mycobacteriosis. A hanseníase é doença infecciosa crônica causada pelo M. leprae. A predileção pela pele e nervos periféricos confere características peculiares a esta moléstia, tornando o seu diagnóstico simples na maioria dos casos. Em contrapartida, o dano neurológico responsabiliza-se pelas seqüelas que podem surgir. Constitui importante problema de saúde pública no Brasil e em vários países do mundo (Tabela 1), e persiste como endemia em 15 países ao final de 2000 (prevalência acima de 1,0/10.000 habitantes). Apesar de todo o empenho em sua eliminação, o Brasil continua sendo o seg...

BackgroundLeprosy control is based on early diagnosis and multidrug therapy. For treatment purposes, leprosy patients can be classified as paucibacillary (PB) or multibacillary (MB), according to the number of skin lesions. Studies regarding a uniform treatment regimen (U-MDT) for all leprosy patients have been encouraged by the WHO, rendering disease classification unnecessary.Methodology and findingsAn independent, randomized, controlled clinical trial conducted from 2007 to 2015 in Brazil, compared main outcomes (frequency of reactions, bacilloscopic index trend, disability progression and relapse rates) among MB patients treated with a uniform regimen/U-MDT (dapsone+rifampicin+clofazimine for six months) versus WHO regular-MDT/R-MDT (dapsone+rifampicin+clofazimine for 12 months). A total of 613 newly diagnosed, untreated MB patients with high bacterial load were included. There was no statistically significant difference in Kaplan-Meyer survival function regarding reaction or disability progression among patients in the U-MDT and R-MDT groups, with more than 25% disability progression in both groups. The full mixed effects model adjusted for the bacilloscopic index average trend in time showed no statistically significant difference for the regression coefficient in both groups and for interaction variables that included treatment group.During active follow up, four patients in U-MDT group relapsed representing a relapse rate of 2.6 per 1000 patients per year of active follow up (95% CI [0·81, 6·2] per 1000). During passive follow up three patients relapsed in U-MDT and one in R-MTD. As this period corresponds to passive follow up, sensitivity analysis estimated the relapse rate for the entire follow up period between 2·9- and 4·5 per 1000 people per year.ConclusionOur results on the first randomized and controlled study on U-MDT together with the results from three previous studies performed in China, India and Bangladesh, support the hypothesis that UMDT is an acceptable option to be adopted in endemic countries to treat leprosy patients in the field worldwide.Trial registrationClinicalTrials.gov: NCT00669643

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