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HAART-associated syndrome tied to leprosy in HIV patients
  NEW YORK (Reuters Health) - Leprosy is a possible immune reconstitution inflammatory syndrome that can develop in HIV-infected patients after highly active antiretroviral therapy (HAART) is initiated, according to French researchers.
In the August issue of the Archives of Dermatology, the investigators describe the cases of three patients undergoing HAART who developed overt symptoms of leprosy.
"The increasing availability of HAART in tropical areas may well reveal latent leprosy cases as a result of an immune reconstitution inflammatory syndrome in patients starting antiretroviral treatment," lead investigator Dr. Pierre Couppie told Reuters Health.
Dr. Couppie of Centre Hospitalier de Cayenne, French Guiana and colleagues note that immune reconstitution inflammatory syndrome has been associated with more than a dozen different infectious conditions, including herpes zoster and cytomegalovirus.
The researchers report on a Haitian man and woman, and a man from French Guiana. All had HIV infection and were receiving HAART. Two were treated at the clinic in Cayenne and the remaining patient, the Haitian woman, was cared for in Martinique.
Two of the patients, say the researchers, "presented an unusual ulcerous progression of the lesions not generally observed in cases of leprosy." However, all the patients responded favorably to antileprosy treatment.
Clofazimine was used in all patients. Other agents, including dapsone and prednisone were also employed.
All three were members of cohort of HIV-infected subjects being followed in another study. Based on this, the researchers conclude that in Martinique and French Guiana, the incidence of immune reconstitution inflammatory syndrome-associated leprosy is 3 per 1000 patients receiving HAART.
The team concludes that "leprosy should be recognized as an immune reconstitution inflammatory syndrome-associated infection" that may have an "atypical presentation."
Arch Dermatol 2004;140:997-1000.


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