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Fróes LAR, Toma TS, Poderoso RE, Trindade MÂB. Viral co-infections in leprosy: a scoping review. Int J Dermatol 2023; 62:547-557. [PMID: 36738114 DOI: 10.1111/ijd.16613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/09/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Luis Alberto Ribeiro Fróes
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 455, São Paulo, 01246-903, SP, Brazil
| | - Tereza Setsuko Toma
- Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
| | | | - Maria Ângela Bianconcini Trindade
- LIM56, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.,Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
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Leprosy as immune reconstitution inflammatory syndrome in patients living with HIV: Description of French Guiana’s cases over 20 years and systematic review of the literature. PLoS Negl Trop Dis 2022; 16:e0010239. [PMID: 35245291 PMCID: PMC8947598 DOI: 10.1371/journal.pntd.0010239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/24/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background HIV infection is highly prevalent in French Guiana, a territory where leprosy is also endemic. Since the introduction of Highly Active Antiretroviral Treatment (HAART) in the management of HIV, leprosy has been reported as part of the immune reconstitution inflammatory syndrome (IRIS). Methodology/Principal findings We aimed to present a general description of these forms of leprosy as IRIS, highlighting clinical and therapeutic specificities. A retrospective study was conducted in French Guiana, including patients living with HIV (PLHIV) with advanced infection (CD4 < 200/mm3) and developing leprosy or a leprosy reaction within six months of HAART initiation, from 2000 to 2020. Clinical, histological and biological data were collected for all these patients. Six patients were reported in French Guiana. A systematic review of the literature was conducted, and its results were added to an overall analysis. Overall, seventy-three PLHIV were included. They were mainly men (74%), aged 22–54 years (median 36 years), mainly from Brazil (46.5%) and India (32.8%). Most leprosy cases (56.2%) were borderline tuberculoid (BT). Leprosy reactions were frequent (74%), mainly type 1 reaction (T1R) (68.5%), sometimes intense with ulceration of skin lesions (22%). Neuritis was observed in 30.1% of patients. The outcome was always favorable under multidrug therapy (MDT), continuation of HAART and additional corticosteroid therapy in case of neuritis or ulceration. There was no relapse. Conclusion Leprosy as IRIS in PLHIV mainly presents as a BT leprosy in a T1R state, sometimes with ulcerated skin lesions. Response to MDT is usually good. Systemic corticosteroids are necessary and efficient in case of neuritis. Leprosy is an infection caused by Mycobacterium leprae characterized by skin and nerve lesions. Leprosy reactions can be observed, depending on variations in host-specific cellular immunity. Leprosy is described after antiretroviral therapy (HAART) initiation in immunocompromised PLHIV from countries where leprosy and HIV infections are endemic. This is known as immune restoration inflammatory syndrome (IRIS), a brutal inflammatory response directed against a latent or quiescent pathogen. In this study we searched for cases of leprosy as IRIS in French Guiana and those published in the literature in order to describe their clinical characteristics. Overall, our results show that these cases are mostly observed as borderline tuberculoid leprosy, associated with or quickly followed by a type 1 leprosy reaction, sometimes with neuritis and/or ulceration of lesions. The outcome is favorable under standard leprosy treatment with HAART maintenance.
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Xavier MB, Pires CAA, Gomes CMDC, Rodrigues GF, Xavier DP, de Brito JAGDSM, Corbett CEP. The expression of FOXP3 in lesions of several forms of leprosy in patients co-infected with HIV. PLoS Negl Trop Dis 2021; 15:e0009887. [PMID: 34748560 PMCID: PMC8601607 DOI: 10.1371/journal.pntd.0009887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/18/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brazil remains endemic for infection by the human immunodeficiency virus (HIV) and leprosy, having a major impact on public health and the life quality of affected patients. Although the relevance of this co-infection is recognized, several aspects, such as the immune response, are not yet fully understood. The objective of this study was to investigate the expression of FOXP3+ Treg cells in leprosy skin lesions and to correlate their clinical forms, laboratory characteristics (CD4, CD8, and CV), and the immune reconstitution syndrome in HIV-leprosy co-infection. METHODOLOGY/PRINCIPAL FINDINGS An observational, cross-sectional, and analytical study was carried out comparing four groups of patients: those with concomitant diagnosis of leprosy and HIV infection without a leprosy reaction, those with leprosy and HIV co-infection patients with a reverse reaction (RR), those with leprosy without HIV and without reaction, and those with leprosywithout HIV and with RR. The patients were diagnosed at a dermatology outpatient clinic located in Belém, Pará, Brazil, from 2003 to 2017. In the sample studied, there was a positive correlation between FOXP3+ cell density and viral load, negative correlation with blood CD4+ (not statistically significant), significant positive correlation in CD8 count in patients with leprosy reaction, and positive relationship in patients with IRIS. The density of cells expressing FOXP3 was higher in the BL/LL forms in patients without HIV, although the difference was not statistically significant. However, the cell mean was higher in the TT/BT forms in patients co-infected with leprosy and HIV, showing contradictory results. CONCLUSIONS/SIGNIFICANCE These findings support that higher activity of the HIV may stimulate or result in a higher expression of FOXP3-Tregs and that they may be involved in active immunosuppression observed at the infection site at the tissue level. This supports the need to expand studies on FOXP3+ Treg cells in co-infected patients.
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Affiliation(s)
- Marília Brasil Xavier
- Research Laboratory in Tropical Dermatology and Endemic Diseases of the Nucleus of Tropical Medicine/Federal University of Pará (NMT/UFPA), Belém, Pará, Brazil
- Research Laboratory on Skin diseases of Sanitary Interest, Biological and Health Sciences Center, State University of Pará (UEPA), Belém, Pará, Brazil
| | - Carla Andréa Avelar Pires
- Research Laboratory in Tropical Dermatology and Endemic Diseases of the Nucleus of Tropical Medicine/Federal University of Pará (NMT/UFPA), Belém, Pará, Brazil
- Research Laboratory on Skin diseases of Sanitary Interest, Biological and Health Sciences Center, State University of Pará (UEPA), Belém, Pará, Brazil
| | - Cláudia Maria de Castro Gomes
- Laboratory of Pathology of Infectious Diseases, Department of Pathology, Medical School, São Paulo University, São Paulo, Brazil
| | - Gabriela Fernandes Rodrigues
- Laboratory of Pathology of Infectious Diseases, Department of Pathology, Medical School, São Paulo University, São Paulo, Brazil
| | - Débora Pinheiro Xavier
- Research Laboratory in Tropical Dermatology and Endemic Diseases of the Nucleus of Tropical Medicine/Federal University of Pará (NMT/UFPA), Belém, Pará, Brazil
| | | | - Carlos Eduardo Pereira Corbett
- Laboratory of Pathology of Infectious Diseases, Department of Pathology, Medical School, São Paulo University, São Paulo, Brazil
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de Sousa JR, Sotto MN, Simões Quaresma JA. Leprosy As a Complex Infection: Breakdown of the Th1 and Th2 Immune Paradigm in the Immunopathogenesis of the Disease. Front Immunol 2017; 8:1635. [PMID: 29234318 PMCID: PMC5712391 DOI: 10.3389/fimmu.2017.01635] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/09/2017] [Indexed: 12/15/2022] Open
Abstract
Leprosy is a chronic infectious disease whose evolution involves complex immune mechanisms of the host that influence the clinical presentation of the disease. For many years, the main interpretation of the host defense response was based on characterization of the established immune paradigm between T helper (Th) 1 and Th2 lymphocytes. However, with advances in the knowledge of immunology, new approaches have emerged along with the development of new immunological pathways that have changed the interpretation of the long-established paradigm of the polar forms of the disease, especially with the identification of new subtypes of T lymphocytes such as Th9, Th17, Th22, and Tregs. Thus, this review discusses the role of these new subtypes of T helper lymphocytes and how the development of the immune response of these cells modifies the pattern of the Th1/Th2 response in the immunopathogenesis of leprosy.
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Affiliation(s)
| | - Mirian Nacagami Sotto
- Faculty of Medicine, Department of Pathology, Sao Paulo University, São Paulo, Brazil
| | - Juarez Antonio Simões Quaresma
- Tropical Medicine Center, Federal University of Pará, Belém, Brazil.,Center of Biological and Health Sciences, State University of Pará, Belém, Brazil
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Fonseca ABDL, Simon MDV, Cazzaniga RA, de Moura TR, de Almeida RP, Duthie MS, Reed SG, de Jesus AR. The influence of innate and adaptative immune responses on the differential clinical outcomes of leprosy. Infect Dis Poverty 2017; 6:5. [PMID: 28162092 PMCID: PMC5292790 DOI: 10.1186/s40249-016-0229-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. According to official reports from 121 countries across five WHO regions, there were 213 899 newly diagnosed cases in 2014. Although leprosy affects the skin and peripheral nerves, it can present across a spectrum of clinical and histopathological forms that are strongly influenced by the immune response of the infected individuals. These forms comprise the extremes of tuberculoid leprosy (TT), with a M. leprae-specific Th1, but also a Th17, response that limits M. leprae multiplication, through to lepromatous leprosy (LL), with M. leprae-specific Th2 and T regulatory responses that do not control M. leprae replication but rather allow bacterial dissemination. The interpolar borderline clinical forms present with similar, but less extreme, immune biases. Acute inflammatory episodes, known as leprosy reactions, are complications that may occur before, during or after treatment, and cause further neurological damages that can cause irreversible chronic disabilities. This review discusses the innate and adaptive immune responses, and their interactions, that are known to affect pathogenesis and influence the clinical outcome of leprosy.
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Affiliation(s)
- Adriana Barbosa de Lima Fonseca
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marise do Vale Simon
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Rodrigo Anselmo Cazzaniga
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Tatiana Rodrigues de Moura
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil
| | - Roque Pacheco de Almeida
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil.,Instituto de Investigação em Imunologia, Institutos Nacionais de Ciência e Tecnologia, CNPq, São Paulo, SP, Brazil
| | | | | | - Amelia Ribeiro de Jesus
- Department of Medicine, Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brazil. .,Instituto de Investigação em Imunologia, Institutos Nacionais de Ciência e Tecnologia, CNPq, São Paulo, SP, Brazil.
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Hirai KE, Aarão TLDS, Silva LM, de Sousa JR, de Souza J, Dias LB, Carneiro FRO, Fuzii HT, Quaresma JAS. Langerhans cells (CD1a and CD207), dermal dendrocytes (FXIIIa) and plasmacytoid dendritic cells (CD123) in skin lesions of leprosy patients. Microb Pathog 2015; 91:18-25. [PMID: 26639680 DOI: 10.1016/j.micpath.2015.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 01/10/2023]
Abstract
The clinical course of infection with Mycobacterium leprae varies widely and depends on the pattern of the host immune response. Dendritic cells play an important role in the activation of the innate and adaptive immune system and seem to be essential for the development of the disease. To analyze the presence of epidermal dendritic cells (CD1a and CD207), plasmacytoid dendritic cells (CD123) and dermal dendrocytes (factor XIIIa) in lesion fragments of leprosy patients, skin samples from 30 patients were studied. These samples were submitted to immunohistochemistry against CD1a, CD207, FXIIIa, and CD123. The results showed a larger number of Langerhans cells, detected with the CD1a or CD207 marker, dermal dendrocytes and plasmacytoid dendritic cells in patients with the tuberculoid form. A positive correlation was observed between the Langerhans cell markers CD1a and CD207 in both the tuberculoid and lepromatous forms, and between Langerhans cells and dermal dendrocytes in samples with the tuberculoid form. The present results indicate the existence of a larger number of dendritic cells in patients at the resistant pole of the disease (tuberculoid) and suggest that the different dendritic cells studied play a role, favoring an efficient immune response against infection with M. leprae.
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Affiliation(s)
- Kelly Emi Hirai
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | | | - Luciana Mota Silva
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | | | - Juarez de Souza
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | - Leonidas Braga Dias
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | | | - Hellen Thais Fuzii
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Para, Brazil
| | - Juarez Antonio Simões Quaresma
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil; Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Para, Brazil.
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Pires CAA, Miranda MFRD, Bittencourt MDJS, Brito ACD, Xavier MB. Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients. An Bras Dermatol 2015; 90:27-34. [PMID: 25672296 PMCID: PMC4323695 DOI: 10.1590/abd1806-4841.20153048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 02/03/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Leprosy and HIV are diseases that have a major impact on public health in Brazil.
Patients coinfected with both diseases, appear to be at higher risk to develop
leprosy reactions. OBJECTIVE The aim of this study is to describe the histopathological aspects of cutaneous
lesions during reactional states in a group of patients with HIV-leprosy
coinfection, compared to patients with leprosy, without coinfection. METHODS Two groups were established: group 1 comprised of 40 patients coinfected with
HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients
presenting reactional states of leprosy had their lesions biopsied and
comparatively evaluated. RESULTS Reversal reaction was the most frequent feature in both groups, with dermis edema
as the most common histopathological finding. Giant cells were seen in all group 1
histopathological examinations. Dermis edema was the most common finding in
patients with erythema nodosum leprosum. CONCLUSION Few histopathological differences were found in both groups, with reversal
reaction as the most significant one, although this fact should be analyzed
considering the predominant BT clinical form in the coinfected group and BB form
in the group without HIV. Larger prospective studies in patients with HIV-leprosy
coinfection are needed to confirm and broaden these results.
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Parente JNT, Talhari C, Schettini APM, Massone C. T regulatory cells (TREG)(TCD4+CD25+FOXP3+) distribution in the different clinical forms of leprosy and reactional states. An Bras Dermatol 2015; 90:41-7. [PMID: 25672298 PMCID: PMC4323697 DOI: 10.1590/abd1806-4841.20153311] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/27/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Leprosy is characterized histologically by a spectrum of different granulomatous
skin lesions, reflecting patients' immune responses to Mycobacterium leprae.
Although CD4+CD25+ FoxP3+ T regulatory cells are pivotal in the immuneregulation,
presence, frequency, and distribution of Tregs in leprosy, its reactional states
have been investigated in few studies. OBJECTIVES This study aimed to verify the frequency and distribution of regulatory T cells in
different clinical forms and reactional states of leprosy. METHODS We performed an immunohistochemical study on 96 leprosy cases [Indeterminate (I):
9 patients; tuberculoid tuberculoid: 13 patients; borderline tuberculoid: 26
patients; borderline borderline: 3 patients; borderline lepromatous: 8 patients;
lepromatous lepromatous: 27 patients; reversal reaction: 8 patients; and erythema
nodosum leprosum: 2 patients]. RESULTS FoxP3-positive cells were present in 100% of the cases with an average density of
2.82% of the infiltrate. Their distribution was not related to granulomatous
structures or special locations. There was a statistically significant increment
of FoxP3 expression in patients with leprosy reversal reactions when compared with
patients presenting with type I leprosy (P= 0.0228); borderline tuberculoid
leprosy (P = 0.0351) and lepromatous leprosy (P = 0.0344). CONCLUSIONS These findings suggest that Tregs play a relevant role in the etiopathogenesis of
leprosy, mainly in type I leprosy reaction.
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de Oliveira AL, Amadeu TP, de França Gomes AC, Menezes VM, da Costa Nery JA, Pinheiro RO, Sarno EN. Role of CD8(+) T cells in triggering reversal reaction in HIV/leprosy patients. Immunology 2013; 140:47-60. [PMID: 23566249 DOI: 10.1111/imm.12108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 04/01/2013] [Accepted: 04/03/2013] [Indexed: 11/29/2022] Open
Abstract
It has been reported that the initiation of highly active anti-retroviral therapy (HAART) is associated with the development of reversal reaction (RR) in co-infected HIV/leprosy patients. Nevertheless, the impact of HIV and HAART on the cellular immune response to Mycobacterium leprae (ML) remains unknown. In the present study, we observed that ex vivo peripheral blood mononuclear cells (PBMCs) of both RR and RR/HIV patients presented increased percentages of activated CD4(+) T cells when compared with the healthy individuals (HC) group. The frequency of CD8(+) CD38(+) cells increased in the PBMCs of RR/HIV patients but not in RR patients when compared with the HC group. Both RR and RR/HIV skin lesion cells presented similar percentages of activated CD4(+) cells, but the numbers of activated CD8(+) cells were higher in RR/HIV in comparison to the RR group. The frequency of interferon-γ-producing cells was high in response to ML regardless of HIV co-infection. In ML-stimulated cells, there was an increase in central memory CD4(+) T-cell frequencies in the RR and RR/HIV groups, but an increase in central memory CD8(+) T-cell frequency was only observed in the RR/HIV group. ML increased granzyme B(+) effector memory CD8(+) T-cell frequencies in the RR/HIV PBMCs, but not in the HC and RR groups. Our data suggest that the increased expression of effector memory CD8(+) T cells, together with greater perforin/granzyme B production, could be an additional mechanism leading to the advent of RR in co-infected patients. Moreoever, this increased expression may explain the severity of RR occurring in these patients.
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Human immunodeficiency virus and leprosy coinfection: challenges in resource-limited setups. Case Rep Med 2012; 2012:698513. [PMID: 22649458 PMCID: PMC3357522 DOI: 10.1155/2012/698513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 03/04/2012] [Accepted: 03/07/2012] [Indexed: 11/17/2022] Open
Abstract
Mycobacteria leprae(leprosy) and HIV coinfection are rare in Kenya. This is likely related to the low prevalence (1 per 10,000 of population) of leprosy. Because leprosy is no longer a public health challenge there is generally a low index of suspicion amongst clinicians for its diagnosis. Management of a HIV-1-leprosy-coinfected individual in a resource-constrained setting is challenging. Some of these challenges include difficulties in establishing a diagnosis of leprosy; the high pill burden of cotreatment with both antileprosy and antiretroviral drugs (ARVs); medications' side effects; drug interactions; scarcity of drug choices for both diseases. This challenge is more profound when managing a patient who requires second-line antiretroviral therapy (ART). We present an adult male patient coinfected with HIV and leprosy, who failed first-line antiretroviral therapy (ART) and required second-line treatment. Due to limited choices in antileprosy drugs available, the patient received monthly rifampicin and daily lopinavir-/ritonavir-based antileprosy and ART regimens, respectively. Six months into his cotreatment, he seemed to have adequate virological control. This case report highlights the challenges of managing such a patient.
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Evaluation of cellular phenotypes implicated in immunopathogenesis and monitoring immune reconstitution inflammatory syndrome in HIV/leprosy cases. PLoS One 2011; 6:e28735. [PMID: 22205964 PMCID: PMC3244401 DOI: 10.1371/journal.pone.0028735] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 11/14/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is now evident that HAART-associated immunological improvement often leads to a variety of new clinical manifestations, collectively termed immune reconstitution inflammatory syndrome, or IRIS. This phenomenon has already been described in cases of HIV coinfection with Mycobacterium leprae, most of them belonging to the tuberculoid spectrum of leprosy disease, as observed in leprosy reversal reaction (RR). However, the events related to the pathogenesis of this association need to be clarified. This study investigated the immunological profile of HIV/leprosy patients, with special attention to the cellular activation status, to better understand the mechanisms related to IRIS/RR immunopathogenesis, identifying any potential biomarkers for IRIS/RR intercurrence. METHODS/PRINCIPAL FINDINGS Eighty-five individuals were assessed in this study: HIV/leprosy and HIV-monoinfected patients, grouped according to HIV-viral load levels, leprosy patients without HIV coinfection, and healthy controls. Phenotypes were evaluated by flow cytometry for T cell subsets and immune differentiation/activation markers. As expected, absolute counts of the CD4+ and CD8+ T cells from the HIV-infected individuals changed in relation to those of the leprosy patients and controls. However, there were no significant differences among the groups, whether in the expression of cellular differentiation phenotypes or cellular activation, as reflected by the expression of CD38 and HLA-DR. Six HIV/leprosy patients identified as IRIS/RR were analyzed during IRIS/RR episodes and after prednisone treatment. These patients presented high cellular activation levels regarding the expression of CD38 in CD8+ cells T during IRIS/RR (median: 77,15%), dropping significantly (p<0,05) during post-IRIS/RR moments (median: 29,7%). Furthermore, an increase of cellular activation seems to occur prior to IRIS/RR. CONCLUSION/SIGNIFICANCE These data suggest CD38 expression in CD8+ T cells interesting tool identifying HIV/leprosy individuals at risk for IRIS/RR. So, a comparative investigation to leprosy patients at RR should be conducted.
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