Human Immunodeficiency Virus and Leprosy

Abstract

From the earliest reports of what has since become the pandemic of human immunodefi ciency virus (HIV) infection, a close association between HIV infection and a previously un common mycobacterial disease-that due to infection with Mycobacterium avium complex (MAC)-was evident. 1 Then and since, clinically significant disease due to MAC is restricted to HIV-positive people in industrialized countries. Later it was realized that M. tuberculosis is associated with HIV infection to the extent that, in sub-Saharan Africa, tuberculosis is clinically the most important opportunistic disease in HIV-positive people.2 A significant proportion of the population there is latently infected with M. tuberculosis, and it is thought that HIV infection, by its progressive destruction of cell mediated immunity, permits the reactivation of tuberculous lesions. What about M. /eprae and HTV? Tn Africa, which today has the greatest number of HTV-infected people of all the continents, leprosy is still relatively common. Further, India has the greatest number of known cases of leprosy in the world, and appears to be on the rising curve of an HTV epidemic potentially as significant as that in Africa.3 So, an interaction between the two infections could be important. In fact, despite expectations,4-7 little interaction has been observed. The potential interactions and complications are many. HTV infection could: I increase the probability of infection with M. /eprae; 2 increase the probability of clinical leprosy developing in a dually infected person; 3 alter the clinical pattern of leprosy; 4 alter the response to anti leprosy chemotherapy.

An update on the diagnosis and treatment of leprosy

“…It is advisable to postpone pregnancy temporarily during post-therapy period if there is evidence of reaction, relapse, or neuritis. 22,23 Unlike in tuberculosis, HIV disease has not had a significant impact on the clinical course of treated and untreated leprosy. However, it has been reported that the neuritis in co-infected people can be more severe and the reversal reaction may be more frequent after therapy.…”

The Continuing Challenges of Leprosy

“…It has been suggested that this may be due to the relatively low virulence of M. leprae or that HIV-infected individuals may die before leprosy (with its long incubation time) becomes clinically apparent (238). Nelson (286) has recently urged that investigators explore alternative explanations, however, since the apparent dissociation between the two diseases has continued even as the prevalence of AIDS has increased.…”

“…Unlike tuberculosis, leprosy has not been observed to be more frequent in patients infected with human immunodeficiency virus (HIV) in regions where both diseases are endemic (162,238,303). It has been suggested that this may be due to the relatively low virulence of M. leprae or that HIV-infected individuals may die before leprosy (with its long incubation time) becomes clinically apparent (238).…”

Modified fine‐needle aspiration technique for diagnosis of granulomatous skin lesions with special reference to leprosy and cutaneous tuberculosis

“…Surprisingly, the HIV infection has not affected the incidence/prevalence of leprosy. 11,12 This study comprised 40 cases of clinically diagnosed cutaneous tuberculosis and leprosy. The aim was to assess the usefulness of cytology, especially by applying the modified FNA technique, in diagnosing these diseases, by identifying characteristic cytological features.…”