Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil

Abstract

BackgroundLeprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood.Methodology/Principal FindingsTwo cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients’ reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome.Conclusions/SignificanceThis study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses.

Leprosy Reactions: Clinical and Therapeutic Profile of Patients Registered at a Dermatology Reference Center in Brazil

“…The largest number of patients (69.23%) came from the metropolitan area of Belém, in the north of Brazil, where the Dermatology Service of the University is located. This situation is similar to the one in the study of Soares [15] and Pires [16], which evidenced a higher demand also coming from the metropolitan region, where the research was carried out, possibly due to greater ease of access.…”

Reação hansênica reversa associada à síndrome de reconstituição imune

“…5,8,9 Apesar da infecção pelo vírus HIV ter baixo impacto no desenvolvimento e evolução da Hanseníase, essa micobacteriose, bem como os quadros reacionais associados a ela, podem se apresentar, como manifestação de síndrome de reconstituição imune. 2,3 Não existem critérios bem estabelecidos para o diagnóstico de reação hansênica, entretanto um estudo realizado em Recife, no estado de Pernambuco, avaliando 201 pacientes com história de quadro reacional, considerou para o diagnóstico de reação reversa pelo menos uma das seguintes manifestações clínicas:…”

“…Após vários estudos observou-se que em pacientes coinfectados uma condição parece não predispor ou piorar a outra. 2 Alguns dos pacientes coinfectados tratados com terapia antirretroviral (TARV) apresentam quadro de reação hansênica tipo 1, também chamada de reação reversa, logo após melhora da imunidade, portanto, sugere-se que esse quadro reacional faça parte, nesses casos, da síndrome de reconstituição imune (SRI), 3,4 fenômeno no qual o sistema imunológico começa a se recuperar, mas responde a uma infecção oportunista adquirida 5,6 Nesses casos os pacientes devem manter o tratamento padrão para ambas as patologias.…”

Neurological Complications of Leprosy

“…One study found that the prevalence of leprosy reactions in coinfected patients and those with only leprosy were comparable, 73% in the former and 75% in the latter. 100 However, another study found that coinfected patients had a greater occurrence of neuritis and increased odds of overall peripheral neuropathy, especially with MB forms. 22 Coinfected patients may be treated effectively with both MDT and highly active antiretroviral therapy (HAART), 101 although severe peripheral neuropathy following HAART had been reported, suggestive of leprosy-associated immune reconstitution inflammatory syndrome.…”