Co-infection with HIV-1 and M. Leprae is a rare event in endemic areas for
leprosy and HIV, such as India. Neither an increased HIV prevalence among
leprosy cases, nor any rapid progression to
AIDS was observed among dual HIV-
leprosy infections. The current situation concerning continued new
leprosy case-detection and gradual increase in
HIV infection in India and a few other developing countries, such as Brazil, emphasizes the importance of monitoring the occurrence of
co-infections. There is so far no change in the clinical spectrum of
leprosy, PB/MB ratio,
leprosy reactions and
neuritis among co-infected patients. All types of
leprosy occur in HIV patients [except in one study (Borgdorff et al, 1993) where more MB
leprosy cases with
HIV infection were seen]. Histopathological observations reveal a normal spectrum of appearance in biopsies of
leprosy lesions from co-infected patients suggesting that cell-mediated immune response to M leprae is preserved at the site of the disease, despite evidence that these responses are abrogated systemically. All dual
infection cases respond to regular treatment, except in three studies which noted more relapses. Therefore, a longer duration of surveillance is advisable after fixed duration
therapy, for the detection of early relapse. Type 2 reaction can be managed with a higher dose of
clofazimine. Type 1 reaction when developed as such, or as IRIS, needs oral
steroids in adequate doses, particularly when associated with
neuritis and motor loss, since lower doses may not be able to reverse the motor loss even of early onset. However, higher doses of
corticosteroid when given need to be monitored closely. The impact of immune restoration in co-infected patients receiving ART is commonly observed in cases with
borderline leprosy.