Peripheral nerve abnormality in HIV leprosy patients

Abstract

BackgroundThe geographical overlap of HIV (human immunodeficiency virus) and leprosy infection has become increasingly frequent and worrying, bringing many clinical issues. Peripheral neuropathy is very frequent in leprosy because of the predilection of its etiologic agent by Schwann cells of the peripheral nervous system, and it also affects individuals with HIV as one of the most common neurological manifestations.Methodology/Principal findingsThe present study compared a cohort of 63 patients diagnosed with leprosy and coinfected with HIV with a cohort of 64 patients with leprosy alone, who were followed at the outpatient clinic of the Nucleus of Tropical Medicine of the Federal University of Pará, Brazil. We observed that HIV-coinfected leprosy patients presented greater odds of overall peripheral nerve damage (nerve function impairment—NFI) than patients with leprosy alone. More sensitive damage was observed, especially in patients coinfected with multibacillary forms. Leprosy patients coinfected with HIV presented higher chances of motor damage with improvement over time using multidrug therapy (MDT) and highly active antiretroviral therapy (HAART), along with a greater extent of damage and occurrence of neuritis. The data suggest that in addition to patients presenting possible damage caused by leprosy, they also had a greater damage gradient attributable to HIV disease, but not related to HAART because most of these patients had been on the treatment for less than a year. Neuritis was treated with prednisone at doses recommended by the WHO, and coinfected patients had the highest rate of clinical improvement in the first 60 days.Conclusions/SignificanceThe clinical characteristics of the two diseases should be considered in leprosy patients coinfected with HIV for better diagnosis and treatment of peripheral neuropathy. We suggest that new simplified assessment tools that allow the evaluation of the NFI of these patients be developed for use in the service.

A comparative study of the conduction velocity of motor and sensory fibres of ulnar and median nerves among leprosy patients and normal subjects

“…Cabalar et.al., in their study found that Ulnar nerve was the most commonly affected nerve in their study and abnormalities were frequent even on non-enlarged nerves. [21][22][23][24][25] Granger et.al., in their study, reported bilateral abnormal conduction velocity in right Median and Ulnar nerves (non-responsive). 26 Anita et.al., also found decreased elbow-wrist MNCV in Ulnar nerves they tested during their study.…”

Neurological Complications of Leprosy

“…For example, a study in Brazil of 63 patients coinfected with leprosy and HIV found greater odds of overall peripheral nerve damage, with a specifically increased likelihood of motor involvement. 22…”

“…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. 102…”

“…Coinfections pose unique challenges in identifying overlapping symptoms and in treatment decisions, as will be discussed in a subsequent section. 22…”

Macrophage Polarization in Leprosy–HIV Co-infected Patients

“…The presence of co-infection may have an impact on leprosy outcome. Previous studies demonstrated that viral co-infection is associated with higher rates of neuritis and nerve function impairment as well as higher relapse rates when compared with patients without co-infection (10,11). Leprosy patients with HIV-1 are rare, but it was demonstrated that patients receiving highly active antiretroviral therapy (HAART) have a greater chance to develop RR (12)(13)(14).…”