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Moritz TB, Ribeiro LME, Piñeiro MJ, Feijó BP, Leide W. de OM. Leprosy reaction and immune reconstitution syndrome in AIDS. Hansen. Int. [Internet]. 30º de junho de 2008 [citado 27º de dezembro de 2024];33(1):25-33. Disponível em: https://periodicos.saude.sp.gov.br/hansenologia/article/view/35176
Resumo
The authors report seven cases of borderline leprosy in AIDS patients whose presentation form was of a type I reaction diagnosed soon HAART introduction, which led to the discussion of the immunological aspects involved in the reaction to leprosy and the immune reconstitution syndrome. The patients were in frank AIDS-induced immune deterioration, which was the reason they met the criteria to initiate HAART treatment. It is likely that due to this fact, the amount of CD4 cells increased at the same time that a reduction of the viral load occurred, allowing the installation of a basically Th1 immunological profile. Therefore, the leprosy infection, which was dormant and unable to express itself was exteriorized in the form of a reverse reaction.
Referências
1 Sampaio EP, Caneshi JRT, Nery JA, Duppre NC, Pereira GM, Vieira LM, et al. Cellular immune response to M.leprae infection in human immunodeficiency virus-infected individuals. Infect immunity 1995; 63:1848-54.
2 Lanjeawar DN, Bhosale A, Lyer A. Spectrum of dermatopathologic lesions associated with HIV/AIDS in India. Indian J Pathol Microbiol 2002; 45 (3): 293-8.
3 Moses AE, Adelano KA, Ajayi BB.Prevalence of HIV-1 infection among patients with leprosy and pulmonary tuberculosis in a semi-arid region, Nigeria. J R Soc Health 2003; 123 (2):117-9.
4 Souza LCS, Martelli CMT, Netto JCA, Stefani MMA, Pereira LIA. Potenciais implicações da co-infecção HIV e Mycobacterium leprae em saúde pública. Rev Patol Trop 1999; 28 (2): 139–64.
5 Miller RA. Leprosy and AIDS: a review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae. Int J Lepr Other Mycobact Dis 1991; 59(4):639-44.
6 World Health Organization Report of the Eighth Meeting of the WHO Techical Advisory Group on Leprosy Control. Aberdeen, Schotland; 21th April 2006.
7 Deps PD, Lockwood DN. Leprosy occurring as immune reconstitution syndrome. Trans R Soc Trop Med Hyg 2008 Oct; 102(10):966-8. Epub 2008 Jul 18
8 Brazilian Ministry of Health. Inserção da assistência farmacêutica na política de acesso universal à terapia antiretroviral. Programa Nacional de DST / Aids. Disponível em: http:// www. aids.gov/MS/SVS/PN/DST.
9 Lawn SD, Lockwood DNJ. Leprosy after starting antiretroviral treatment – an increasingly reported clinical ploblem but not a serious public health risk. BMJ 2007; (334): 217 – 8.
10 Brito AM, Castilho EA, Swarcwald CL. AIDS and HIV infection in Brazil: a multifaceted epidemic. Rev Soc Bras Med Trop 2000; 34 (2): 207-17.
11 Bingham JS, Handa S. Dermatological immune restoration syndrome: does it exist? JEADV 2001;(15): 430-2.
12 Lawn SD, Wood C, Lockwood DN. Borderline tuberculoid leprosy: an immune reconstitution phenomenon in a human immunodeficiency virus-infected person. Clin Infect Dis 2003; 36(1):5-6.
13 Behrens GM, Meyer D, Stoll M, Schmidt RE. Immune reconstitution syndromes in human immuno-deficiency virus infection following effective antiretroviral therapy. Immunobiology 2000; 202(2):186-93.
14 Coupie P, Abel S, Voinchet H, Roussel M, Helenon R, Huerre M, et al. Immune reconstitution inflammatory syndrome associated with HIV and leprosy. Arch Dermatol 2004; 140(8): 997 –1000
15 Singal A, Mehta S, Pandhi D. Immune Reconstitution Inflammatory Syndrome in a HIV leprosy patient. Lepr Rev 2006; 77 (1): 76 – 80.
16 Kharkar V, Bhor UH, Mahajan S, Khopkar U. Type I lepra reaction presenting as immune reconstitution inflammatory syndrome. Indian J Dermatol Venereal Leprol 2007 JulAug;73(4):253-6.
17 Sampaio EP, Moraes MO, Pessolani MCV, Sarno EM. Role of Th1 Cytokines in Host Defenses Against Mycobacterium leprae. In: Kobt M , Kalandra T. Cytokines in Infectious Diseases Handbook. Totowa, NJ: Human Press Inc; 2003. p. 163-86.
18 Trope BM, Rotava P, Leitão D, Goes S, Oliveira MLW. Participação das lesões cutâneo-mucosas na definição de casos de AIDS. Annals of the 570 . Braziliam Congress of Dermatology; 2002 Sept; Porto Alegre, Brazil.
19 Pfaltzgraff RE, Bryceson A. Clinical Leprosy. In: Hastings RC, ed. Leprosy. Edinburgh: Churchill Livinstone; 1985. p. 134-76.
20 Oliveira MLW.Cura da hanseníase: magnitude das recidivas no Brasil, fatores de risco e estudo de coortes de diferentes esquemas de tratamento [PHD Thesis]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 1996.
21 Hirsch HH, Kaufmann G, Sendy P, Battegay M. Immune Reconstitution in HIV–Infected Patients. Clin Infect Dis 2004; (38): 1159 –66.
22 Pignataro P, Silva RA, Nery JA, Miranda A, Sales AM, Ferreira H, et al. Leprosy and AIDS: two cases of increasing inflammatory reactions at the start of highly active therapy. Eur J Clin Microbiol Infect Dis 2004; 23 (5):408-11.
23 Pereira GAS, Stefani MMA, Araújo Filho JA, Souza LCS, Stefani GP, Martelli CMT. Humam Immunodeficiency virus type I (HIV-1) and Mycobacterium leprae co-infection: HIV-1 subtypes and clinical, immunologic, and histopathologic profiles in a Brazilian cohort. Am J Trop Med Hyg 2004; 71(5): 679-84.
2 Lanjeawar DN, Bhosale A, Lyer A. Spectrum of dermatopathologic lesions associated with HIV/AIDS in India. Indian J Pathol Microbiol 2002; 45 (3): 293-8.
3 Moses AE, Adelano KA, Ajayi BB.Prevalence of HIV-1 infection among patients with leprosy and pulmonary tuberculosis in a semi-arid region, Nigeria. J R Soc Health 2003; 123 (2):117-9.
4 Souza LCS, Martelli CMT, Netto JCA, Stefani MMA, Pereira LIA. Potenciais implicações da co-infecção HIV e Mycobacterium leprae em saúde pública. Rev Patol Trop 1999; 28 (2): 139–64.
5 Miller RA. Leprosy and AIDS: a review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae. Int J Lepr Other Mycobact Dis 1991; 59(4):639-44.
6 World Health Organization Report of the Eighth Meeting of the WHO Techical Advisory Group on Leprosy Control. Aberdeen, Schotland; 21th April 2006.
7 Deps PD, Lockwood DN. Leprosy occurring as immune reconstitution syndrome. Trans R Soc Trop Med Hyg 2008 Oct; 102(10):966-8. Epub 2008 Jul 18
8 Brazilian Ministry of Health. Inserção da assistência farmacêutica na política de acesso universal à terapia antiretroviral. Programa Nacional de DST / Aids. Disponível em: http:// www. aids.gov/MS/SVS/PN/DST.
9 Lawn SD, Lockwood DNJ. Leprosy after starting antiretroviral treatment – an increasingly reported clinical ploblem but not a serious public health risk. BMJ 2007; (334): 217 – 8.
10 Brito AM, Castilho EA, Swarcwald CL. AIDS and HIV infection in Brazil: a multifaceted epidemic. Rev Soc Bras Med Trop 2000; 34 (2): 207-17.
11 Bingham JS, Handa S. Dermatological immune restoration syndrome: does it exist? JEADV 2001;(15): 430-2.
12 Lawn SD, Wood C, Lockwood DN. Borderline tuberculoid leprosy: an immune reconstitution phenomenon in a human immunodeficiency virus-infected person. Clin Infect Dis 2003; 36(1):5-6.
13 Behrens GM, Meyer D, Stoll M, Schmidt RE. Immune reconstitution syndromes in human immuno-deficiency virus infection following effective antiretroviral therapy. Immunobiology 2000; 202(2):186-93.
14 Coupie P, Abel S, Voinchet H, Roussel M, Helenon R, Huerre M, et al. Immune reconstitution inflammatory syndrome associated with HIV and leprosy. Arch Dermatol 2004; 140(8): 997 –1000
15 Singal A, Mehta S, Pandhi D. Immune Reconstitution Inflammatory Syndrome in a HIV leprosy patient. Lepr Rev 2006; 77 (1): 76 – 80.
16 Kharkar V, Bhor UH, Mahajan S, Khopkar U. Type I lepra reaction presenting as immune reconstitution inflammatory syndrome. Indian J Dermatol Venereal Leprol 2007 JulAug;73(4):253-6.
17 Sampaio EP, Moraes MO, Pessolani MCV, Sarno EM. Role of Th1 Cytokines in Host Defenses Against Mycobacterium leprae. In: Kobt M , Kalandra T. Cytokines in Infectious Diseases Handbook. Totowa, NJ: Human Press Inc; 2003. p. 163-86.
18 Trope BM, Rotava P, Leitão D, Goes S, Oliveira MLW. Participação das lesões cutâneo-mucosas na definição de casos de AIDS. Annals of the 570 . Braziliam Congress of Dermatology; 2002 Sept; Porto Alegre, Brazil.
19 Pfaltzgraff RE, Bryceson A. Clinical Leprosy. In: Hastings RC, ed. Leprosy. Edinburgh: Churchill Livinstone; 1985. p. 134-76.
20 Oliveira MLW.Cura da hanseníase: magnitude das recidivas no Brasil, fatores de risco e estudo de coortes de diferentes esquemas de tratamento [PHD Thesis]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 1996.
21 Hirsch HH, Kaufmann G, Sendy P, Battegay M. Immune Reconstitution in HIV–Infected Patients. Clin Infect Dis 2004; (38): 1159 –66.
22 Pignataro P, Silva RA, Nery JA, Miranda A, Sales AM, Ferreira H, et al. Leprosy and AIDS: two cases of increasing inflammatory reactions at the start of highly active therapy. Eur J Clin Microbiol Infect Dis 2004; 23 (5):408-11.
23 Pereira GAS, Stefani MMA, Araújo Filho JA, Souza LCS, Stefani GP, Martelli CMT. Humam Immunodeficiency virus type I (HIV-1) and Mycobacterium leprae co-infection: HIV-1 subtypes and clinical, immunologic, and histopathologic profiles in a Brazilian cohort. Am J Trop Med Hyg 2004; 71(5): 679-84.
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