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Co-infections with human immunodeficiency virus (HIV) and Mycobacterium leprae represent unique opportunities to investigate the interaction of both pathogens. We determined the immunologic, virologic, and histopathologic characteristics of 22 co-infected Brazilian patients (median age = 38 years, 81.8% males, 72.2% with paucibacillary leprosy, and 95.4% with acquired immunodeficiency syndrome). The HIV-1 subtypes B and BF predominated in envelope and gag heteroduplex mobility analysis. Borderline tuberculoid (BT), tuberculoid, lepromatous, and indeterminate morphology with CD3+, CD8+, and CD68+ cell distributions compatible with leprosy patients not infected with HIV were observed. Histologic evidence of nerve damage was observed in BT lesions. IgM antibody to M. leprae-specific phenolic glycolipid I was not detected. Two of six co-infected patients monitored during highly active antiretroviral therapy (HAART) developed a leprosy type 1 reaction after an increase in CD4+ cells, suggesting an immune restoration phenomenon. Clinical, immunologic, histopathologic, and virologic features among these HIV-leprosy co-infected patients indicate that each disease progressed as in single infection. However, HAART immune reconstitution may trigger potential adverse effects, such as leprosy acute inflammatory episodes.
Received March 29, 2004. Accepted for publication June 4, 2004.
Acknowledgments: The following reagents were obtained through the AIDS Research and Reference Reagent Program, Division of AIDS, NIAID, NIH: Heteroduplex Mobility Analysis HIV-1 env Subtyping Kit from Dr. James Mullins and gag Subtyping Kit from Dr. Guido van der Groen, Leo Heyndrickx, and Gert van der Auwera.
Financial support: This study was supported by the CNPq (Brazilian Research Council grant no. 400183/99), and Conselho de Ciência e Tecnologia do Estado de Goiás (grant no. 243).
Authors’ addresses: Gisner A. S. Pereira, Mariane M. A. Stefani, Germana P. Stefani, and Celina M. T. Martelli, Tropical Pathology and Public Health Institute, Federal University of Goiás, Rua Delenda Rezende de Melo, s/n Setor Universitario, 74 605 050 Goiânia-Goiás, Brazil, Telephone: 55-62-209-6111, Fax: 55-62-5211839, E-mails: gisner{at}terra.com.br, mstefani{at}iptsp.ufg.br, gestefani{at}zipmail.com.br, and celina{at}iptsp.ufg.br. João A. Araújo Filho, Tropical Pathology and Public Health Institute, Federal University of Goiás, Rua Delenda Rezende de Melo, s/n Setor Universitario, 74 605 050 Goiânia-Goiás, Brazil and Anuar Auad Hospital, Avenida Contorno No. 3556, Jardim Bela Vista, 74 575 240 Goiânia, Goiás, Brazil, E-mail: caraujo{at}cultura.com.br. Luís Carlos S. Souza, Anuar Auad Hospital, Avenida Contorno No. 3556, Jardim Bela Vista, 74 575 240 Goiânia, Goiás, Brazil, E-mail: lmuar{at}cultura.com.br.
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