Viral Co-infection and Leprosy Outcomes: A Cohort Study.
BACKGROUND
The role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses.


RESULTS
Cohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02-18.74.


CONCLUSIONS
Leprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients.
Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil; Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais, Salvador, Bahia, Brazil.
Paulo R L
PR
Machado
Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil.
Lídia M
LM
Machado
Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil.
Mayume
M
Shibuya
Immunology Service, Federal University of Bahia, Salvador, Bahia, Brazil.
Jamile
J
Rego
Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America; Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America.
Warren D
WD
Johnson
Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York, United States of America.
Marshall J
MJ
Glesby
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D060085:Coinfection / Q000150:complications / Q000382:microbiology* / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D015490:HTLV-I Infections / Q000821:virology; D016174:Hepacivirus / Q000502:physiology; D006509:Hepatitis B / Q000821:virology; D006515:Hepatitis B virus / Q000502:physiology; D006526:Hepatitis C / Q000821:virology; D015368:Human T-lymphotropic virus 1 / Q000502:physiology; D006801:Humans; D007918:Leprosy / Q000150:complications / Q000382:microbiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000502:physiology; D055815:Young Adult