1921
Volume 71, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Co-infections with human immunodeficiency virus (HIV) and 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 -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.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2004.71.679
2004-11-01
2017-09-19
Loading full text...

Full text loading...

/deliver/fulltext/14761645/71/5/0700679.html?itemId=/content/journals/10.4269/ajtmh.2004.71.679&mimeType=html&fmt=ahah

References

  1. Hawkins CC, Gold JW, Whimbey E, Kiehn TE, Brannon P, Cammarata R, Brown AE, Armstrong D, 1986. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med 105 : 184–188.
  2. Pitchenik AE, Cole C, Russell BW, Fischl MA, Spira TJ, Snider DE Jr, 1984. Tuberculosis, atypical mycobacteriosis, and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients in south Florida. Ann Intern Med 101 : 641–645.
  3. Leonard G, Sangare A, Verdier M, Sassou-Guesseau E, Petit G, Milan J, M’Boup S, Rey JL, Dumas JL, Hugon J, N’Gaporo I, Denis F, 1990. Prevalence of HIV infection among patients with leprosy in African countries and Yemen. J Acquir Immune Defic Syndr 3 : 1109–1113.
  4. Lawn SD, 2004. AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection. J Infect 48 : 1–12.
  5. Koup RA, Safrit JT, Cao Y, Andrews CA, McLeod G, Borkowsky W, Farthing C, Ho DD, 1994. Temporal association of cellular immune responses with the initial control of viremia in primary human immunodeficiency virus type 1 syndrome. J Virol 68 : 4650–4655.
  6. Yamamura M, Wang XH, Ohmen JD, Uyemura K, Rea TH, Bloom BR, Modlin RL, 1992. Cytokine patterns of immunologically mediated tissue damage. J Immunol 149 : 1470–1475.
  7. Stefani MMA, Martelli CMT, Gillis TP, Krahenbuhl JL, and the Brazilian Leprosy Study Group, 2003. In situ type 1 cytokine gene expression and mechanisms associated with early leprosy progression. J Infect Dis 188 : 1024–1031.
  8. Spierings E, de Boer T, Zulianello L, Ottenhoff TH, 2000. The role of Schwann cells, T cells and Mycobacterium leprae in the immunopathogenesis of nerve damage in leprosy. Lepr Rev 71 : S121–S129.
  9. Lienhardt C, Kamate B, Jamet P, Tounkara A, Faye OC, Sow SO, Bobin P, 1996. Effect of HIV infection on leprosy: a three-year survey in Bamako, Mali. Int J Lepr Other Mycobact Dis 64 : 383–391.
  10. Sampaio EP, Caneshi JR, Nery JA, Duppre NC, Pereira GM, Vieira LM, Moreira AL, Kaplan G, Sarno EM, 1995. Cellular immune response to Mycobacterium leprae infection in human immunodeficiency virus-infected individuals. Infect Immun 63 : 848–854.
  11. Kawuma HJ, Bwire R, Adatu-Engwau F, 1994. Leprosy and infection with the human immunodeficiency virus in Uganda: a case-control study. Int J Lepr Other Mycobact Dis 62 : 521–526.
  12. Lucas S, 1993. Human immunodeficiency virus and leprosy. Lepr Rev 64 : 97–103.
  13. Ponnighaus JM, Mwanjasi LJ, Fine PE, Shaw MA, Turner AC, Oxborrow SM, Lucas SB, Jenkins PA, Sterne JA, Bliss L, 1991. Is HIV infection a risk factor for leprosy? Int J Lepr Other Mycobact Dis 59 : 221–228.
  14. Boletim Epidemiológico AIDS, Ano XVI no. 01, 2002. Available at http://www.aids.gov.br. Accessed August 28, 2003.
  15. World Health Organization Leprosy - Global Situation, 2000. Wkly Epidemiol Rec 735 : 225–232.
  16. Young D, 2003. Prospects for molecular epidemiology of leprosy. Lepr Rev 74 : 11–17.
  17. Thomson MM, Perez-Alvarez L, Najera R, 2002. Molecular epidemiology of HIV-1 genetic forms and its significance for vaccine development and therapy. Lancet Infect Dis 2 : 461–471.
  18. HIV-1 Diversity. Available at http://hiv-web.lanl.go. Accessed March 12, 2003.
  19. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD, 1998. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338 : 853–860.
  20. DeSimone JA, Pomerantz RJ, Babinchak TJ, 2000. Inflammatory reactions in HIV-1-infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med 133 : 447–454.
  21. Lawn SD, Wood C, Lockwood DNJ, 2003. Borderline tuberculoid leprosy: an immune reconstitution phenomenon in a human immunodeficiency virus-infected person. Clin Infect Dis 36 : 5–6.
  22. Lockwood DNJ, 2002. Leprosy elimination - a virtual phenomenon or a reality? BMJ 324 : 1516–1518.
  23. Guia de Vigilância Epidemiológica, 2002. Brasília: Fundaçao Nacional de Saude. Fifth edition. No. 6.
  24. HMA Env Subtyping Protocol Version 5. Available at http://ubik.microbiol.washington.edu/HMA/index.html. Accessed February 22, 2000.
  25. HMA Gag Subtyping Protocol. Available at www.itg.be/microbiol/gagHMA.html. Accessed May 5, 2002.
  26. HMA Env and Gag Subtyping Kits - NIH/AIDS Reagent Program. Available at www.aidsreagent.org. Accessed May 15, 2000 and August 22, 2002.
  27. Cho SN, Yanagihara DL, Hunter SW, Gelber RH, Brennan PJ, 1983. Serological specificity of phenolic glycolipid I from Mycobacterium leprae and use in serodiagnosis of leprosy. Infect Immun 41 : 1077–1083.
  28. Stefani MMA, Martelli CMT, Morais-Neto OL, Martelli P, Costa MB, Andrade AL, 1998. Assessment of anti-PGL-I as a prognostic marker of leprosy reaction. Int J Lepr Other Mycobact Dis 66 : 356–364.
  29. Morgado MG, Barcellos C, Pina MF, Bastos FI, 2000. Human immunodeficiency virus/acquired immunodeficiency syndrome and tropical diseases: a Brazilian perspective. Mem Inst Oswaldo Cruz 95 (Suppl 1): 145–151.
  30. Stefani MM, Pereira GA, Martelli CM, Shindo N, Galvao-Castro B, 2000. Evidence of HIV-1 genetic diversity among pregnant women with AIDS or infected with HIV-1 in central Brazil (letter). J Acquir Immune Defic Syndr 23 : 205–207.
  31. Lienhardt C, Fine PE, 1994. Type 1 reaction, neuritis and disability in leprosy. What is the current epidemiological situation? Lepr Rev 65 : 9–33.
  32. Scollard DM, Smith T, Bhoopat, Theetranont C, Rangdaeng S, Morens DM, 1994. Epidemiologic characteristics of leprosy reactions. Int J Lepr Other Mycobact Dis 62 : 559–567.
  33. Britton WJ, 1998. The management of leprosy reversal reactions. Lepr Rev 69 : 225–234.
  34. Nery JA, Sampaio EP, Galhardo MC, Perisse AR, Vieira LM, Salles AM, Sarno EN, 2000. M. leprae-HIV co-infection: pattern of immune response in vivo and in vitro. Indian J Lepr 72 : 155–167.
  35. Kennedy C, Lien RA, Stolz E, van Joost T, Naafs B, 1990. Leprosy and immunodeficiency virus infection. A closer look at the lesions. Int J Dermatol 29 : 139–140.
  36. Roche PW, Britton WJ, Failbus SS, Williams D, Pradhan MH, Theuvenet WJ, 1990. Operational value of serological measurements in multibacillary leprosy patients: clinical and bacteriological correlates of antibody responses. Int J Lepr Other Mycobact Dis 58 : 480–490.
  37. Cho SN, Cellona RV, Villahermosa LG, Fajardo TT Jr, Balagon MV, Abalos RM, Tan EV, Walsh GP, Kim JD, Brennan PJ, 2001. Detection of phenolic glycolipid I of Mycobacterium leprae in sera from leprosy patients before and after start of multidrug therapy. Clin Diagn Lab Immunol 8 : 138–142.
  38. Gormus BJ, Murphey-Corb M, Marin LN, Baskin GB, Mack PA, Ratteree MS, Gerone PJ, Scollard DM, Gillis TP, 1998. Impaired responses to Mycobacterium leprae antigens in rhesus monkeys experimentally inoculated with simian immunodeficiency virus and M. leprae. Lepr Rev 69 : 24–39.
  39. Gonzalez-Abreu E, Rodriguez ME, Perez J, Rodriguez J, Gonzalez A, 1993. PGLI antibody in HIV infected patients. Lepr Rev 64 : 275–283.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2004.71.679
Loading
/content/journals/10.4269/ajtmh.2004.71.679
Loading

Data & Media loading...

  • Received : 29 Mar 2004
  • Accepted : 04 Jun 2004

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error