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Abstract
Mycobacterium leprae: an opportunistic infection in HIV/AIDS
Bartholomew C.1, Suite M.2, Edwards J.3, Boyce G.3, Valdez S.3
1Medical Research Centre, Port of Spain, Trinidad and Tobago, 2Port of Spain General Hospital, Port of Spain, Trinidad and Tobago, 3Medical 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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