title: Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil.
abstract: BACKGROUND
  Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood.
  
  
  RESULTS
  Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients' reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome.
  
  
  CONCLUSIONS
  This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses.
authors.affiliation: Department of Dermatology, Division of Tropical Skin Diseases, Section of Leprosy, Universidade Federal do Pará, Belém, Pará, Brazil; Department of Dermatology, Division of Tropical Skin Diseases, Section of Leprosy, Universidade do Estado do Pará, Belém, Pará, Brazil.
authors.forename: Carla Andréa Avelar
authors.initials: CA
authors.lastname: Pires
authors.affiliation: Department of Dermatology, Division of Tropical Skin Diseases, Section of Leprosy, Universidade do Estado do Pará, Belém, Pará, Brazil.
authors.forename: Fernando Octávio Machado
authors.initials: FO
authors.lastname: Jucá Neto
authors.affiliation: Department of Infectious Diseases, Division of Tropical Diseases, Section of Leprosy, Universidade Federal do Pará, Belém, Pará, Brazil.
authors.forename: Nahima Castelo
authors.initials: NC
authors.lastname: de Albuquerque
authors.affiliation: Department of Infectious Diseases, Division of Tropical Diseases, Section of Epidemiological Vigilance, Universidade Federal do Pará, Belém, Pará, Brazil.
authors.forename: Geraldo Mariano Moraes
authors.initials: GM
authors.lastname: Macedo
authors.affiliation: Department of Infectious Diseases, Division of Tropical Diseases, Section of Leprosy, Universidade Federal do Pará, Belém, Pará, Brazil.
authors.forename: Keila de Nazaré Madureira
authors.initials: Kde N
authors.lastname: Batista
authors.affiliation: Department of Dermatology, Division of Tropical Skin Diseases, Section of Leprosy, Universidade Federal do Pará, Belém, Pará, Brazil; Department of Dermatology, Division of Tropical Skin Diseases, Section of Leprosy, Universidade do Estado do Pará, Belém, Pará, Brazil; Department of Infectious Diseases, Division of Tropical Diseases, Section of Leprosy, Universidade Federal do Pará, Belém, Pará, Brazil.
authors.forename: Marília Brasil
authors.initials: MB
authors.lastname: Xavier
mesh_terms: D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D056006:Leprosy, Multibacillary / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D056005:Leprosy, Paucibacillary / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D008137:Longitudinal Studies; D015995:Prevalence