title: Clinical and histological features of leprosy and human immunodeficiency virus co-infection in Brazil.
abstract: BACKGROUND
  Both leprosy and human immunodeficiency virus (HIV) are infectious diseases, and are an important global health problem. Patients with leprosy who are co-infected with HIV seem to be at higher risk of developing leprosy reactions.
  
  
  OBJECTIVE
  To examine the histological features of leprosy in patients with HIV and leprosy co-infection, particularly to determine whether the typical leprosy histopathology is present in skin biopsies, and to assess the histological features of leprosy reactions in co-infected patients.
  
  
  METHODS
  This was a matched cohort study with 11 co-infected patients and 31 HIV-negative patients with leprosy. A structured protocol for skin-biopsy evaluation was followed, focusing on inflammation of the skin and dermal nerves.
  
  
  RESULTS
  Of the 11 HIV-positive patients, 7 (63%) had borderline tuberculoid (BT) leprosy and 5 (70%) of these 7 patients had developed a type 1 reaction. The lesions in these patients were immunologically active, with 100% of biopsies having evidence of compact granulomas, 90% evidence of oedema and 30% evidence of necrosis.
  
  
  CONCLUSIONS
  In this study, patients co-infected with HIV and M. leprae had the typical histological lesions of leprosy. There was evidence of immune activation in patients who received combination antiretroviral therapy, and these patients had BT leprosy and leprosy-upgrading reactions.
authors.affiliation: Department of Social Medicine, Federal University of Espírito Santo, Vitória, ES, Brazil. pdeps@uol.com.br
authors.forename: P
authors.initials: P
authors.lastname: Deps
authors.forename: S
authors.initials: S
authors.lastname: Lucas
authors.forename: A M
authors.initials: AM
authors.lastname: Porro
authors.forename: S M
authors.initials: SM
authors.lastname: Maeda
authors.forename: J
authors.initials: J
authors.lastname: Tomimori
authors.forename: C
authors.initials: C
authors.lastname: Guidella
authors.forename: T
authors.initials: T
authors.lastname: Reuter
authors.forename: N S
authors.initials: NS
authors.lastname: Oliveira
authors.forename: B P R
authors.initials: BP
authors.lastname: Madureira
authors.forename: V A
authors.initials: VA
authors.lastname: Souza
authors.forename: R M
authors.initials: RM
authors.lastname: Loureiro
authors.forename: B L
authors.initials: BL
authors.lastname: Alves
authors.forename: A
authors.initials: A
authors.lastname: Bellone
authors.forename: D N J
authors.initials: DN
authors.lastname: Lockwood
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection / Q000276:immunology / Q000473:pathology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000276:immunology; D006801:Humans; D007918:Leprosy / Q000276:immunology / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D055815:Young Adult