Kwobah Charles M, Wools-Kaloustian Kara K, Gitau Jane N, Siika Abraham M
USAID-Academic Model Providing Access to Healthcare (AMPATH) partnership, P.O. Box 4606-30100, Eldoret, Kenya.
Case Rep Med. 2012;2012:698513. doi: 10.1155/2012/698513. Epub 2012 May 9.
Mycobacteria leprae(leprosy) and HIV coinfection are rare in Kenya. This is likely related to the low prevalence (1 per 10,000 of population) of leprosy. Because leprosy is no longer a public health challenge there is generally a low index of suspicion amongst clinicians for its diagnosis. Management of a HIV-1-leprosy-coinfected individual in a resource-constrained setting is challenging. Some of these challenges include difficulties in establishing a diagnosis of leprosy; the high pill burden of cotreatment with both antileprosy and antiretroviral drugs (ARVs); medications' side effects; drug interactions; scarcity of drug choices for both diseases. This challenge is more profound when managing a patient who requires second-line antiretroviral therapy (ART). We present an adult male patient coinfected with HIV and leprosy, who failed first-line antiretroviral therapy (ART) and required second-line treatment. Due to limited choices in antileprosy drugs available, the patient received monthly rifampicin and daily lopinavir-/ritonavir-based antileprosy and ART regimens, respectively. Six months into his cotreatment, he seemed to have adequate virological control. This case report highlights the challenges of managing such a patient.
在肯尼亚，麻风分枝杆菌（麻风病）与人类免疫缺陷病毒（HIV）合并感染的情况较为罕见。这可能与麻风病的低流行率（每10000人中1例）有关。由于麻风病已不再构成公共卫生挑战，临床医生对其诊断的怀疑指数普遍较低。在资源有限的情况下，管理HIV-1与麻风病合并感染的个体具有挑战性。其中一些挑战包括难以确诊麻风病；同时使用抗麻风病药物和抗逆转录病毒药物（ARV）进行联合治疗时药物负担过重；药物副作用；药物相互作用；两种疾病的药物选择匮乏。当管理一名需要二线抗逆转录病毒治疗（ART）的患者时，这一挑战更为严峻。我们报告了一名同时感染HIV和麻风病的成年男性患者，他一线抗逆转录病毒治疗（ART）失败，需要二线治疗。由于可用的抗麻风病药物选择有限，该患者分别接受了每月一次的利福平治疗以及基于洛匹那韦/利托那韦的每日抗麻风病和ART联合治疗方案。联合治疗六个月后，他似乎实现了足够的病毒学控制。本病例报告突出了管理此类患者的挑战。
