Leprosy occurring as immune reconstitution syndrome.
Immune reconstitution inflammatory syndrome (IRIS) may occur in HIV-infected patients after starting highly active antiretroviral therapy (HAART). Since 2003, 19 cases were published as IRIS. Leprosy has been reported as an example of an IRIS, and it is important that this syndrome should be recognized in leprosy-endemic areas. The case definition of leprosy as IRIS is based on clinical presentation of leprosy, evidence of immune restoration and timing of onset. Case definition should include the following: (1) leprosy and/or leprosy type 1 reaction presenting within six months of starting HAART; (2) advanced HIV infection; (3) low CD4+ count before start HAART; (4) CD4+ count increasing after HAART has been started. Although pathogenic mechanisms are still unclear, it is likely that leprosy-associated IRIS will be increasingly reported in those countries endemic for both diseases and as access to HAART becomes more widely available.
Deps
Patricia D
PD
Department of Social Medicine, Federal University of Espirito Santo, Vitoria-ES, Brazil. patricia.deps@lshtm.ac.uk
Lockwood
Diana N J
DN
D017088:AIDS-Related Opportunistic Infections / Q000139:chemically induced* / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced*; D007918:Leprosy / Q000139:chemically induced* / Q000276:immunology