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HAART-Associated
Syndrome Linked to Leprosy in HIV Patients
Leprosy
is a possible immune reconstitution inflammatory
syndrome that can develop in HIV-infected patients after HAART
is initiated, according to French researchers.
In the August issue of the Archives of Dermatology, the investigators
describe the cases of three patients undergoing HAART who developed
overt symptoms of leprosy.
"The
increasing availability of HAART in tropical areas may well reveal
latent leprosy cases as a result of an immune reconstitution inflammatory
syndrome in patients starting antiretroviral treatment," lead
investigator Dr. Pierre Couppie told Reuters Health.
Dr.
Couppie of Centre Hospitalier de Cayenne, French Guiana and colleagues
note that immune reconstitution inflammatory syndrome has been associated
with more than a dozen different infectious conditions, including
herpes zoster and cytomegalovirus.
The
researchers report on a Haitian man and woman, and a man from French
Guiana. All had HIV infection and were receiving HAART. Two were
treated at the clinic in Cayenne and the remaining patient, the
Haitian woman, was cared for in Martinique.
Two
of the patients, say the researchers, "presented an unusual
ulcerous progression of the lesions not generally observed in cases
of leprosy." However, all the patients responded favorably
to antileprosy treatment.
Clofazimine
was used in all patients. Other agents, including dapsone and prednisone
were also employed.
All
three were members of cohort of HIV-infected subjects being followed
in another study. Based on this, the researchers conclude that in
Martinique and French Guiana, the incidence of immune reconstitution
inflammatory syndrome-associated leprosy is 3 per 1000 patients
receiving HAART.
The
team concludes that "leprosy should be recognized as an immune
reconstitution inflammatory syndrome-associated infection"
that may have an "atypical presentation."
09/13/04
Arch Dermatol 2004;140:997-1000.
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