02502nas a2200457   4500000000100000008004100001260001300042653001000055653000900065653001100074653002500085653001900110653001600129653001100145653001900156653001100175653001200186653000900198653001600207653001600223100001100239700001200250700001400262700001400276700001500290700001500305700001300320700001700333700002000350700001400370700001700384700001400401700001400415700001600429245010700445300001000552490000700562050001400569520144700583022001402030       2013                            d  c2013 Jul10aAdult10aAged10aBrazil10aCD4 Lymphocyte Count10aCohort Studies10aCoinfection10aFemale10aHIV Infections10aHumans10aleprosy10aMale10aMiddle Aged10aYoung Adult1 aDeps P1 aLucas S1 aPorro A M1 aMaeda S M1 aTomimori J1 aGuidella C1 aReuter T1 aOliveira N S1 aMadureira B P R1 aSouza V A1 aLoureiro R M1 aAlves B L1 aBellone A1 aLockwood DN00aClinical and histological features of leprosy and human immunodeficiency virus co-infection in Brazil.  a470-70 v38  aDEPS 20133 a<p><b>BACKGROUND: </b>Both leprosy and human immunodeficiency virus (HIV) are infectious diseases, and are an important global health problem. Patients with leprosy who are co-infected with HIV seem to be at higher risk of developing leprosy reactions.</p><p><b>AIM: </b>To examine the histological features of leprosy in patients with HIV and leprosy co-infection, particularly to determine whether the typical leprosy histopathology is present in skin biopsies, and to assess the histological features of leprosy reactions in co-infected patients.</p><p><b>METHODS: </b>This was a matched cohort study with 11 co-infected patients and 31 HIV-negative patients with leprosy. A structured protocol for skin-biopsy evaluation was followed, focusing on inflammation of the skin and dermal nerves.</p><p><b>RESULTS: </b>Of the 11 HIV-positive patients, 7 (63%) had borderline tuberculoid (BT) leprosy and 5 (70%) of these 7 patients had developed a type 1 reaction. The lesions in these patients were immunologically active, with 100% of biopsies having evidence of compact granulomas, 90% evidence of oedema and 30% evidence of necrosis.</p><p><b>CONCLUSIONS: </b>In this study, patients co-infected with HIV and M. leprae had the typical histological lesions of leprosy. There was evidence of immune activation in patients who received combination antiretroviral therapy, and these patients had BT leprosy and leprosy-upgrading reactions.</p>  a1365-2230