3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

MYCOBACTERIUM LEPRAE: AN OPPORTUNISTIC INFECTION IN HIV/AIDS

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WePp0302

Bartholomew C.¹, Suite M.², Edwards J.³, Boyce G.³, Valdez S.^3
1 Medical Research Centre, Port of Spain, Trinidad and Tobago, ² Port of Spain General Hospital, Port of Spain, Trinidad and Tobago, ³ Medical Research Foundation, Port of Spain, Trinidad and Tobago

BACKGROUND: The risk of active tuberculosis (TB) with latent infection with Mycobacterium tuberculoses is increased 100-fold by HIV infection and HIV promotes TB co-infection at all CD4 strata. However, relatively few reports exist of such an association of Hansen's disease due to the Mycobacterium leprae and HIV infection. Between 1990 – 1992, a cross-sectional study conducted in Rio de Janeiro, Brazil failed to document any association between HIV-1 infection and Hansen's disease. A study in Mali (1996) concluded that HIV is a major risk factor with tuberculosis and other mycobacteria but the association with Hansen's disease remains unclear. In another publication (1996) during a period of 9 years, 4 male patients with HIV and Hansen's disease were detected in Nadu, South India, however, it is unclear which infection occurred first.

METHODS: Hansen's disease occurs at low levels in Trinidad and Tobago (pop. 1.3 million) with an annual prevalence rate of 6 – 10 per 100,000 population. HIV antibody testing were performed on all patients with leprosy attending the Dermatology Clinic of the Port of Spain General Hospital, Trinidad from 1990 onwards.

RESULTS: This is the first report from the Caribbean of patients with Hansen's disease, who were found to be HIV-1 antibody positive. All 7 patients had symptoms of AIDS and infection with HIV preceded the onset of clinical Hansen's disease as suggested by their low CD4+ cell counts (<200cells/mm³) at the time of first presentation with Hansen's disease.

CONCLUSIONS: The average incubation period of Hansen's disease is probably about 4 years for tuberculoid leprosy and twice that for lepromatous leprosy. Latent and subclinical infection with Mycobacterium leprae may be expressed clinically by superinfection with HIV. There are also a few case reports in the literature suggesting the presentation of leprosy from immune reconstitution after therapy with HAART.

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Clinical | WePp0302 | Courtenay Bartholomew
Other co-infections

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