Immune reconstitution inflammatory syndrome or upgrading Type 1 reaction? Report of two AIDS patients presenting a shifting from borderline lepromatous leprosy to borderline tuberculoid leprosy

Abstract

It would be expected that AIDS had a major impact on the incidence and clinical course of leprosy in countries where both diseases are public health problems. However, epidemiological changes such as those seen in tuberculosis have not been observed in leprosy and HIV coinfection. Although a slight increase in HIV seroprevalence among leprosy patients has been observed in a few cohort and case control studies, – 5 there have been no changes in the leprosy incidence in the majority of leprosy endemic areas. – 9 Currently, there are few reports of HIV-positive patients on HAART presenting with multibacillary leprosy. In a recent review there were only two cases (borderline-lepromatous and borderline-borderline leprosy). The large majority were classified as borderlinetuberculoid leprosy. – 14 It is well known that there is an important CD4 count increase during the first few months of HAART. During this phase, a subgroup of patients may present with clinical deterioration despite the CD4 count improvement. This immunopathological inflammatory response to a wide range of pre-existing infectious agents has been called immune reconstitution inflammatory syndrome