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J. Clin. Microbiol. doi:10.1128/JCM.01425-06
Copyright (c) 2006, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Two Mycobacterium leprae and Human Immunodeficiency Virus Type-1 Coinfected Patients Naïve for Antiretroviral Therapy with Type 1 Leprosy Reactions Mimicking the Immune Reconstitution Inflammatory Syndrome

Department of Dermatology, Medical School of the University of São Paulo, Brazil; Health Institute, São Paulo State Health Department, Brazil; Center of Dermatology, São Paulo State Health Department, Brazil; Emílio Ribas Infectious Diseases Institute, São Paulo State Health Department Brazil; Lauro de Souza Lima Institute of the São Paulo State Health Department, Brazil; Leiden University Medical Centre (LUMC) Leiden, The Netherlands

^* To whom correspondence should be addressed. Email: angelatrindade{at}uol.com.br.

	Abstract

Two case reports on patients with Human Immunodeficiency Virus (HIV)-Type 1 infection who developed leprosy are presented. Both developed type 1 leprosy reactions in absence of antiretroviral therapy. Reactions have been described in a number of HIV-1 and Mycobacterium leprae coinfected patients, and have been considered to be part of an Immune Reconstitution Inflammatory Syndrome (IRIS) since the reactions were usually linked to the administration of highly active antiretroviral therapy. The reports of our two patients suggest that the type 1 reactions in leprosy and HIV coinfected patients may not always be an IRIS manifestation, but may be akin to the classical reactional state as described during the natural course of a leprosy infection, which occurs in leprosy patients due to the fluctuations of the anti-mycobacterial immune response, whether coinfected with HIV or not.