Leprosy and AIDS: a review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae
Miller, R.A.
International Journal of Leprosy and other Mycobacterial Diseases Official Organ of the International Leprosy Association 59(4): 639-644
1991
ISSN/ISBN: 0148-916X PMID: 1687045 Document Number: 326080
A literature search of coinfection with HIV and leprosy retrieved 4 case reports, 4 epidemiologic studies, 2 primate studies, and an editorial The 1st case was a 43-year old male with borderline tuberculoid leprosy who was successfully treated with dapsone and clofazimine, but later developed Kaposi's sarcoma and pulmonary tuberculosis. The 2nd case was a 28-year old male from Martinique who had been treated with triple therapy (dapsone, rifampin, and clofazimine) for lepromatous disease with erythema nodosum leprosum for 9 years, but later developed reactive polyarthritis and 1+ bacterial index along with generalized lymphadenopathy with his HIV. A 3rd case was a 27-year old male who had been treated for cutaneous leprosy for 4 years. 5 years later he had polyneuropathy and palpable nerve trunks suggestive of a reversal reaction, and candida esophagitis with a CD4/CD8 ratio of 0.3. The 4th case was a 35-year old woman with BT-BB leprosy on clinical grounds, but apparent BL leprosy by histology. It was also noted that her granulomas had a high CD4+ lymphocyte count, while her circulating CD4/CD8 ratio was 0.6 with a low CD4 count of 300. The 4 epidemiologic series were from Zambia, Haiti, Ethiopia, and a large series of cases from Ivory Coast, Congo, Senegal, and Yemen. Some preliminary conclusions from these data were that HIV infection does not affect the clinical classification of leprosy, that HIV infection may confer anergy to lepromin, that HIV infection may cause relapse of leprosy, and that leprosy may accelerate the progression of HIV. There were 2 cases where leprosy grading reaction reversed or downgraded in coinfected patients. In the primate model, coinfection with SIV and M. leprae increases susceptibility of monkeys to leprosy.