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HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1) AND MYCOBACTERIUM LEPRAE CO-INFECTION: HIV-1 SUBTYPES AND CLINICAL, IMMUNOLOGIC, AND HISTOPATHOLOGIC PROFILES IN A BRAZILIAN COHORT

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  • 1 Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia, Goiás, Brazil; Anuar Auad Hospital, Goiânia, Goiás, Brazil

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.

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