Sarno Euzenir Nunes, Illarramendi Ximena, Nery José A Costa, Sales Anna M, Gutierrez-Galhardo Maria C, Penna Maria L Fernandes, Sampaio Elizabeth Pereira, Kaplan Gilla
Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Public Health Rep. 2008 Mar-Apr;123(2):206-12. doi: 10.1177/003335490812300213.
It has been speculated that, as seen in tuberculosis, human immunodeficiency virus (HIV) and Mycobacterium leprae (M. leprae) co-infection may exacerbate the pathogenesis of leprosy lesions and/or lead to increased susceptibility to leprosy. However, to date, HIV infection has not appeared to increase susceptibility to leprosy. In contrast, initiation of antiretroviral treatment (ART) has been reported to be associated with anecdotal activation of M. leprae infection and exacerbation of existing leprosy lesions. To determine whether ART is associated with worsening of the manifestations of leprosy, a cohort of leprosy patients recruited between 1996 and 2006 at the Oswaldo Cruz Foundation (FIOCRUZ) Leprosy Outpatient Clinic in Rio de Janeiro, Brazil, was studied longitudinally. ART treatment of HIV/leprosy co-infection was associated with the tuberculoid type, paucibacillary disease, and lower bacillary loads. CD4 lymphocyte counts were higher among HIV/leprosy patients at the time of leprosy diagnosis, while viral loads were lower compared with the time of HIV diagnosis. The conclusion was that ART and immune reconstitution were critical factors driving the development and/or clinical appearance of leprosy lesions.
据推测，正如在结核病中所见，人类免疫缺陷病毒（HIV）与麻风分枝杆菌（M. leprae）合并感染可能会加剧麻风病损的发病机制和/或导致对麻风病易感性增加。然而，迄今为止，HIV感染似乎并未增加对麻风病的易感性。相反，有报道称抗逆转录病毒治疗（ART）的启动与麻风分枝杆菌感染的偶然激活以及现有麻风病损的加重有关。为了确定ART是否与麻风病表现的恶化相关，对1996年至2006年期间在巴西里约热内卢的奥斯瓦尔多·克鲁兹基金会（FIOCRUZ）麻风病门诊招募的一组麻风病患者进行了纵向研究。HIV/麻风病合并感染的ART治疗与结核样型、少菌型疾病以及较低的菌量相关。在麻风病诊断时，HIV/麻风病患者的CD4淋巴细胞计数较高，而病毒载量与HIV诊断时相比更低。结论是ART和免疫重建是推动麻风病损发展和/或临床表现的关键因素。
