Occult hepatitis B virus infection in patients with leprosy

Viral co-infections in leprosy: a scoping review

CONTEXT

The most reported viral co-infections in leprosy are human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), hepatitis B virus (HBV), hepatitis C virus (HCV), and SARS-CoV-2. In co-infections, the burden of an agent can be increased or decreased by the presence of others. To address this issue, we need to fully understand their prevalence, risk factors, immunology, clinical manifestations, and treatment. The purpose of this scoping review is to describe the clinical and epidemiological characteristics of the most reported viral co-infections in leprosy to inform clinicians and guide future research.

METHODS

The authors conducted a literature search of five databases for articles on each of the aforementioned co-infections published prior to October 2022. Two independent reviewers conducted the selection process and identified 53 papers meeting the study inclusion criteria. The data extraction process and evidence synthesis were conducted by one reviewer and double-checked by a second one, consistent with best practice recommendations for scoping reviews.

RESULTS

For all assessed viruses, most studies reported prevalence rates in leprosy patients higher than the general population. Studies found that HTLV, HBV, and HCV chronic infections were highest in multibacillary leprosy, whereas HIV was mostly found in paucibacillary leprosy, and SARS-Cov-2 affected leprosy subtypes equally. Overall, co-infections were also associated with higher rates of leprosy reactions, except for COVID-19. Forty-six percent of the studies discussed issues related to treatment, which led to favorable outcomes for the most part.

CONCLUSIONS

This review summarizes the existing literature on viral co-infections in leprosy patients, generating valuable insights and recommending areas for future research.

Epidemiological and molecular profile of blood donors infected with HTLV-1/2 in the state of Pará, northern Brazil

BACKGROUND

The Human T-lymphotropic virus (HTLV) is a retrovirus of the genus Deltaretrovirus, which belongs to the family Retroviridae. The most important types are HTLV-1 and HTLV-2. It is estimated that between five and 10 million individuals are infected with HTLV-1, worldwide. Studies in the state of Pará indicate that it has the third highest prevalence of HTLV infections of any Brazilian state. The present study describes the epidemiological, serological, and molecular profile of blood donors from the state of Pará that were classified as unfit due to infection by HTLV-1 and 2.

METHODS

The present study is based on a descriptive, retrospective, and cross-sectional review of the epidemiological, serological, and molecular data on blood donations, between January 2015 and December 2019. The data were obtained from the blood bank system and were digitalized to form a database in the Statistical Package for Social Sciences program, version 20. Descriptive statistics were used to determine the absolute and relative frequencies of the qualitative variables. For the quantitative variables, the mean, standard deviation, and minimum and maximum values were calculated. A p < 0.05 significance level was adopted for all analyses.

RESULTS

A total of 632 samples were analyzed, of which 496 (78%) had no detectable proviral DNA and 136 (22%) had detectable HTLV. The HTLV-1 was detected in most (78%; 106/136) of these samples, while only 30 (22%) were detected for HTLV-2. The HTLV proviral DNA was detected primarily in females (69.1%), with a mean age of 40 years, with the highest frequencies of detection being recorded in single individuals (66.2%), first-time donors (74.3%), and individuals that had graduated high school (44.1%). The molecular confirmation of HTLV showed that three-quarters (78%) of the serologically reactive individuals were negative for either types 1 or 2, so the epidemiological profile of these individuals was significantly different from their detectable profile.

CONCLUSIONS

The HTLV is neglected in Brazil; there is thus a clear need for further research in the area of regional hemotherapy and hematology services, in order to contribute to the definition of regional infection profiles, that will be fundamental to the development of effective prophylactic practices for the prevention of the infection and the dissemination of knowledge on the dangers of HTLV in the community.

Causes of Death among Persons Affected by Leprosy in Korea, 2010-2013

In addition to the complications of leprosy, people affected by leprosy (PALs) can suffer from chronic diseases. We evaluated the recent pattern of deaths among Korean PALs and compared it with that in the general population. We analyzed the death certificate data of 1,359 PALs from 2010 through 2013. The all-cause and cause-specific standardized mortality ratio (SMR) and standardized mortality with 95% CI were calculated. Malignancy had the highest standardized mortality, with 130.9 deaths per 100,000 persons, followed by cardiovascular diseases (CVDs; 85.5 deaths) and respiratory diseases (38.2 deaths). Of malignancies, liver cancer caused the greatest number of cancer deaths (40.0 deaths). The all-cause mortality of PALs was significantly lower than that in the general population, corresponding to an SMR of 0.84 (95% CI 0.79-0.88). Deaths from malignancy and CVDs were significantly lower, corresponding to SMRs (95% CIs) of 0.88 (0.79-0.98) and 0.75 (0.67-0.84), respectively. The death rates for lung and stomach cancers were lower, whereas mortality due to liver cancer was higher, with an SMR of 1.79 (95% CI 1.43-2.22). Except for liver cancer and infection, the causes of mortality of PALs tend to be lower than that in the general population. The most common underlying cause of death in PALs was stroke, followed by ischemic heart disease, liver cancer, and pneumonia.