Abstract
Background
Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood.
Methodology/Principal Findings
Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients’ reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome.
Conclusions/Significance
This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses.
Leprosy and HIV infections, separately, are serious modern public health problems. Many studies have been conducted on these diseases, but knowledge gaps remain. This article provides the first account of important clinical information on a significant sample of patients with leprosy, as well as patients with both leprosy and HIV, who were followed over a period of 24 months. We compared the clinical outcome of both groups, observed the occurrence of reactional episodes, and examined the characteristics of these episodes. The sample consisted of 40 co-infected patients (Group 1) and 107 patients with leprosy only (Group 2). Group 1 was characterized by high levels of paucibacillary leprosy cases (70%) and the borderline tuberculoid clinical form (45%), while Group 2 predominantly exhibited multibacillary leprosy (86%) and the borderline clinical form (40.2%). The Type I reaction was present in 13 and 34 patients of Groups 1 and 2, respectively. The Amazon region, where the study was conducted, is an endemic region for both diseases, which can be useful for conducting studies such as these owing to the generalizability of the results. This study seeks to contribute to the knowledge of the natural history of HIV and leprosy comorbidity.
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