Service de Dermatologie, Centre hospitalier de Cayenne, Cayenne, French Guiana.
Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, INSERM, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana.
PLoS Negl Trop Dis. 2022 Mar 4;16(3):e0010239. doi: 10.1371/journal.pntd.0010239. eCollection 2022 Mar.
HIV infection is highly prevalent in French Guiana, a territory where leprosy is also endemic. Since the introduction of Highly Active Antiretroviral Treatment (HAART) in the management of HIV, leprosy has been reported as part of the immune reconstitution inflammatory syndrome (IRIS).
METHODOLOGY/PRINCIPAL FINDINGS: We aimed to present a general description of these forms of leprosy as IRIS, highlighting clinical and therapeutic specificities. A retrospective study was conducted in French Guiana, including patients living with HIV (PLHIV) with advanced infection (CD4 < 200/mm3) and developing leprosy or a leprosy reaction within six months of HAART initiation, from 2000 to 2020. Clinical, histological and biological data were collected for all these patients. Six patients were reported in French Guiana. A systematic review of the literature was conducted, and its results were added to an overall analysis. Overall, seventy-three PLHIV were included. They were mainly men (74%), aged 22-54 years (median 36 years), mainly from Brazil (46.5%) and India (32.8%). Most leprosy cases (56.2%) were borderline tuberculoid (BT). Leprosy reactions were frequent (74%), mainly type 1 reaction (T1R) (68.5%), sometimes intense with ulceration of skin lesions (22%). Neuritis was observed in 30.1% of patients. The outcome was always favorable under multidrug therapy (MDT), continuation of HAART and additional corticosteroid therapy in case of neuritis or ulceration. There was no relapse.
Leprosy as IRIS in PLHIV mainly presents as a BT leprosy in a T1R state, sometimes with ulcerated skin lesions. Response to MDT is usually good. Systemic corticosteroids are necessary and efficient in case of neuritis.
HIV 感染在法属圭亚那（一个麻风病流行的地区）非常普遍。自从引入高效抗逆转录病毒治疗（HAART）以来，麻风病已被报告为免疫重建炎症综合征（IRIS）的一部分。
方法/主要发现：我们旨在介绍这些作为 IRIS 的麻风病形式的一般描述，突出其临床和治疗的特殊性。在法属圭亚那进行了一项回顾性研究，包括 CD4 细胞计数<200/mm3的晚期 HIV 感染（PLHIV）患者，他们在 HAART 开始后六个月内发生麻风病或麻风病反应，研究时间为 2000 年至 2020 年。对所有这些患者收集了临床、组织学和生物学数据。在法属圭亚那报告了六例患者。进行了系统的文献回顾，并将其结果纳入了综合分析。总体上，共纳入了 73 名 PLHIV。他们主要是男性（74%），年龄在 22-54 岁之间（中位数为 36 岁），主要来自巴西（46.5%）和印度（32.8%）。大多数麻风病病例（56.2%）为边界性结核样型（BT）。麻风病反应很常见（74%），主要是 1 型反应（T1R）（68.5%），有时伴有皮肤病变溃疡（22%）。30.1%的患者存在神经炎。多药治疗（MDT）、继续 HAART 以及在出现神经炎或溃疡时额外使用皮质类固醇治疗，结局总是良好的。没有复发。
PLHIV 中的 IRIS 麻风病主要表现为 T1R 状态下的 BT 麻风病，有时伴有皮肤溃疡。MDT 反应通常良好。在出现神经炎的情况下，全身皮质类固醇是必要且有效的。
