title: Reversal reactions in the skin lesions of AMFES patients: incidence and risk factors.
abstract: Reversal reactions affect the skin and/or nerves of leprosy patients. This paper looks at reversal reactions involving the skin in 594 new patients in central Ethiopia, followed for between 6 and 11 years after the start of treatment. The incidence of reversal reaction declines steadily after the start of treatment, but the first episode may occur as long as 5 years after diagnosis in both paucibacillary (PB) and multibacillary (MB) patients. Recurrent episodes occurred up to 6 years after diagnosis. PB patients were at greatest risk for reversal reaction in the first year after diagnosis and MB patients in the first 4 years. The highest incidence rate was 18 episodes per 100 person years in MB patients during the first year after diagnosis. The ratio of the incidence rates for the first 3 years in MB versus PB patients is 2.4 (95% CI 1.6-3.8). This study confirms that starting effective treatment and borderline classification are risk factors for reversal reactions. Pregnancy/delivery in the 6 months prior to diagnosis was a significant risk factor for presenting with a reversal reaction [relative risk (RR) 5.9 (95% CI 2.1-16.5)], but later pregnancies were not associated with an increased risk. Being female was a significant risk factor for the late appearance of the first episode of reversal reaction. Having a reversal reaction in the first year after diagnosis was a highly significant risk factor for the development of later reactions [RR in PB cases 11.9 (95% CI 3.4-41.7); in MB cases 6.4 (95% CI 3.8-10.6)]. Being HIV positive was a risk factor for developing recurrent reversal reactions, although only three out of 29 recurrent cases were HIV positive [RR 2.7 (95% CI 1.4-5.1)].
authors: School of Community Health Science, Nottingham University, UK. psaunderson@leprosy.org
authors: P
authors: P
authors: Saunderson
authors: S
authors: S
authors: Gebre
authors: P
authors: P
authors: Byass
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D018450:Disease Progression; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007917:Leprostatic Agents / Q000008:administration & dosage; D007918:Leprosy / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D007917:Leprostatic Agents