The intersection of human immunodeficiency virus (HIV) and Mycobacterium leprae infection creates unique diagnostic and therapeutic challenges. The roll-out of antiretroviral therapy (ART) has revealed leprosy-associated immune reconstitution inflammatory syndrome (L-IRIS), marked by paradoxical clinical worsening as immune function recovers. This review explores the clinical profiles, immunological mechanisms, and treatment outcomes of L-IRIS and leprosy reactivation in people living with HIV. Scoping review, preferred reporting items for systematic reviews and meta-analyses extension for Scoping review, systematic search: We searched PubMed, Scopus, Embase, Web of Science, LILACS(Latin America and the Caribbean Literature on Health Sciences), and Cochrane Library for original case reports, case series, and cohort studies documenting HIV-leprosy coinfection and IRIS. Data were extracted across six domains: epidemiology, clinical manifestations, histopathology, immunology, therapy, and evidence gaps. Geographic clustering, immunodeficiency, reversal reactions: Eighteen studies were included, predominantly from Brazil, India, and French Guiana. Borderline tuberculoid (BT) leprosy was the commonest clinical form; type 1 reactions (T1R) were the most frequent immune events, usually 2–6 months after ART initiation. Most patients had advanced immunosuppression (CD4+ <100/μL), with clinical IRIS coinciding with immune recovery. Histopathology revealed granulomatous inflammation and CD68+ macrophage infiltration. Standard treatment included World Health Organization-recommended multidrug therapy (MDT) and corticosteroids, yielding generally favorable outcomes; however, there was a lack of consensus on IRIS management, long-term follow-up, and no validated biomarkers for L-IRIS, which remains under-recognized, with significant diversity in presentation and limited standardized diagnostic criteria. Improvement in care requires biomarker validation, consistent outcome tracking, and the creation of context-adapted management pathways. Expanded integrated surveillance and patient-centered research in endemic areas are essential to reduce the dual disease burden.
BT - Indian Journal of Sexually Transmitted Diseases and AIDS DA - 12/2025 DO - 10.4103/ijstd.ijstd_152_25 IS - 2 LA - ENG M3 - Article N2 -The intersection of human immunodeficiency virus (HIV) and Mycobacterium leprae infection creates unique diagnostic and therapeutic challenges. The roll-out of antiretroviral therapy (ART) has revealed leprosy-associated immune reconstitution inflammatory syndrome (L-IRIS), marked by paradoxical clinical worsening as immune function recovers. This review explores the clinical profiles, immunological mechanisms, and treatment outcomes of L-IRIS and leprosy reactivation in people living with HIV. Scoping review, preferred reporting items for systematic reviews and meta-analyses extension for Scoping review, systematic search: We searched PubMed, Scopus, Embase, Web of Science, LILACS(Latin America and the Caribbean Literature on Health Sciences), and Cochrane Library for original case reports, case series, and cohort studies documenting HIV-leprosy coinfection and IRIS. Data were extracted across six domains: epidemiology, clinical manifestations, histopathology, immunology, therapy, and evidence gaps. Geographic clustering, immunodeficiency, reversal reactions: Eighteen studies were included, predominantly from Brazil, India, and French Guiana. Borderline tuberculoid (BT) leprosy was the commonest clinical form; type 1 reactions (T1R) were the most frequent immune events, usually 2–6 months after ART initiation. Most patients had advanced immunosuppression (CD4+ <100/μL), with clinical IRIS coinciding with immune recovery. Histopathology revealed granulomatous inflammation and CD68+ macrophage infiltration. Standard treatment included World Health Organization-recommended multidrug therapy (MDT) and corticosteroids, yielding generally favorable outcomes; however, there was a lack of consensus on IRIS management, long-term follow-up, and no validated biomarkers for L-IRIS, which remains under-recognized, with significant diversity in presentation and limited standardized diagnostic criteria. Improvement in care requires biomarker validation, consistent outcome tracking, and the creation of context-adapted management pathways. Expanded integrated surveillance and patient-centered research in endemic areas are essential to reduce the dual disease burden.
PB - Ovid Technologies (Wolters Kluwer Health) PY - 2025 SP - 112 EP - 118 T2 - Indian Journal of Sexually Transmitted Diseases and AIDS TI - Reactivations, paradoxical reactions, and immune reconstitution in human immunodeficiency virus-associated leprosy: A scoping review of global case patterns, immunopathogenesis, and therapeutic gaps UR - https://www.researchgate.net/publication/398550549_Reactivations_paradoxical_reactions_and_immune_reconstitution_in_human_immunodeficiency_virus-associated_leprosy_A_scoping_review_of_global_case_patterns_immunopathogenesis_and_therapeutic_gaps/fulltext/6 VL - 46 SN - 2589-0557, 2589-0565 ER -