The role of human T cell lymphotrophic virus type 1, hepatitis B virus and hepatitis C virus coinfections in leprosy

Machado, Paulo Roberto Lima; Johnson, Warren D.; Glesby, Marshall J.

doi:10.1590/s0074-02762012000900008

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…6 Comorbid conditions, such as minor bacterial infections, viral hepatitis, and HIV, have been implicated in the etiology of leprosy reactions, although results are mixed. [8][9][10][11][12] A recent cross-sectional study in Indonesia showed an association between soil-transmitted helminths (STH) and a higher occurrence of T2R. 13 This study also showed a higher odds of STH in multibacillary (MB) versus paucibacillary leprosy cases, an association which Diniz et al 14 also demonstrated in Brazil.…”

Section: Introductionmentioning

confidence: 75%

“…role of various coinfections, such as HIV, viral hepatitides, and bacterial infections in leprosy reactions, this higher prevalence of helminth infection in this patient population requires further attention. [10][11][12] Although the underlying immune mechanisms of leprosy reactions are complex, T1R are generally associated with a robust cell-mediated immune response and T2R are associated with immune complex formation and more of a humoral immune response and may have both Th1 and Th2 cytokines. 5,23 As both vitamin A deficiency and helminth infections are associated with suppression of the Th1 immune response, theoretically, a higher risk of T2R and possibly lower risk of T1R could be hypothesized.…”

Section: Discussionmentioning

confidence: 99%

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The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

Fairley

Ferreira²,

Oliveira

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni, Strongyloides, and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy.

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Section: Introductionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

Fairley

Ferreira²,

Oliveira

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…However, Rego et al identified an association with HBV and/or HCV serological markers and a type 1 leprosy reaction, and Machado et al found an association between anti‐HBc positivity and the occurrence of neuritis and neural function deficit in leprosy patients. These studies indicate that the presence of the virus may induce an inflammatory response in the host with the production of proinflammatory cytokines triggering leprosy reactions or influencing the evolution or the outcome of the disease . However, it is still unknown whether the presence of HBV influences the triggering of a leprosy reaction, or conversely if the immunological phenomena characteristic of the leprosy reaction or its treatment with immunosuppressing medications influences viral replication.…”

Section: Discussionmentioning

confidence: 99%

Occult hepatitis B virus infection in patients with leprosy

Costa

Morais

Gonçales

et al. 2018

Journal of Medical Virology

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Leprosy patients may present with immune system impairment and have a higher hepatitis B virus (HBV) seroprevalence, justifying the investigation of occult HBV infection in these individuals. The aim of this study was to verify the frequency and the clinical factors associated with occult HBV infection in leprosy patients. Between 2015 and 2016, leprosy patients from a reference center in Brazil were interviewed to assess clinical data. Blood samples were collected for the screening of HBV serological markers using enzyme‐linked immunosorbent assay. Patients with negative hepatitis B surface antigen (HBsAg) that had positive anti‐HBc and/or anti‐HBs were selected for HBV DNA detection using real‐time polymerase chain reaction. SPSS was used for data analysis. Among 114 selected patients, six were identified with occult infection (5.3%) and five of them with multibacillary leprosy. Three patients with occult infection had a history of a type 2 reaction (P = 0.072; OR, 4.97; 95% CI, 0.87‐28.52). Only two patients with occult infection had isolated anti‐HBc, while three had isolated anti‐HBs, including those with the highest HBV DNA titers. In conclusion, in leprosy patients with negative HBsAg and positive anti‐HBc and/or anti‐HBs, occult HBV infection occurs in 5.3% and can be found even in patients with isolated anti‐HBs.

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“…Since then, numerous studies [ 17 ] have confirmed or refuted this association. Although a higher HBV prevalence among institutionalized patients with leprosy has been found in Brazil, HBV co-infection was not clearly associated with any clinical leprosy outcome [ 18 , 19 , 20 ]. A similar situation has been found regarding HCV co-infection in leprosy, where a higher HCV prevalence was associated with institutionalization and occasionally with lepromatous disease [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…HTLV-1 infection is associated with the release of inflammatory cytokines and with a decrease in T-cell immunity by Th2 cytokine production [ 28 ]. However, several studies of HTLV-1 co-infection in leprosy did not refer to any association with clinical outcomes [ 20 ]. A case report from Brazil describes the development of a T2R in a subject presenting with HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Viral Co-infection and Leprosy Outcomes: A Cohort Study

Machado

Shibuya

et al. 2015

PLoS Negl Trop Dis

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BackgroundThe role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses.Methodology/Principal FindingsCohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02–18.74.Conclusions/SignificanceLeprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients.

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The role of human T cell lymphotrophic virus type 1, hepatitis B virus and hepatitis C virus coinfections in leprosy

Cited by 10 publications

References 33 publications

The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

The Burden of Helminth Coinfections and Micronutrient Deficiencies in Patients with and without Leprosy Reactions: A Pilot Study in Minas Gerais, Brazil

Occult hepatitis B virus infection in patients with leprosy

Viral Co-infection and Leprosy Outcomes: A Cohort Study

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