Short-term follow up of patients with multibacillary leprosy and HIV infection

Abstract

During a period of 9 years, four male patients with HIV and Hansen's disease were detected in Tamil Nadu, South India. The sequence as to which infection came first is not known. All had high-risk sexual behavior with commercial sex workers and a past history of genital ulcer disease. Their spectrum of leprosy was multibacillary. Patient no. 1 had pure neural leprosy of the lepromatous type, which is rare. He also had a single episode of type 1 reaction which did not require steroid therapy. Despite having taken inadequate treatment, patient no. 2 remained clinically and bacteriologically quiescent after 4 years of follow up. He had a low CD4 count of 330 cells/mm3. The third patient completed a full course of multibacillary multidrug therapy, and a year later is clinically and bacteriologically inactive. The fourth patient died of AIDS within 2 months of the dual diagnosis.

PIP: Since the detection of HIV infection in the Christian Medical College and Hospital, Tamil Nadu, in 1986, patients attending the sexually transmitted disease (STD) clinic are counselled and screened for HIV antibodies using ELISA. Over the course of 9 years, 4 males, all from Tamil Nadu, were identified at the clinic with concurrent HIV infection and leprosy. The men were aged 20-27 years and had had multiple heterosexual contacts with prostitutes and a past history of genital ulcer disease. They were in the multibacillary (MB) spectrum of the disease as evidenced by the presence of numerous acid-fast bacilli in the nerve biopsy in 1 case and positive skin smears in the other 3 cases. Mitsuda tests conducted in 3 patients were negative, consistent with the MB spectrum of Hansen's disease (HD). The patients had concurrent infections, but it is unclear which infection occurred first. One patient developed a type 1 reaction which rapidly recovered with nonsteroidal antiinflammatory drugs. Observation of the patient over 3 years revealed no further episodes of reaction. No patient developed an erythema nodosum leprosum (ENL) reaction. One patient died 2 months after being diagnosed with HIV and HD. The other patients were followed for 3-5 years after the diagnosis of dual infection. Over that period, neither their leprosy worsened nor did their HIV infection progress to clinical AIDS. HIV infection therefore does not appear to influence an infection with Mycobacterium leprae.