Peripheral nerve abnormality in HIV leprosy patients
| Autor: | Keila de Nazaré Madureira Batista, Fernando Octavio Machado Juca Neto, Thomaz Xavier Carneiro, Claudia Maria de Castro Gomes, Mariana Garcia Borges do Nascimento, Marilia Brasil Xavier, Danusa Neves Somensi, Carlos Eduardo Pereira Corbett |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Bacterial Diseases
RNA viruses Male Physiology Neuritis Sensory Physiology HIV Infections Leprostatic Agents Pathology and Laboratory Medicine Nervous System Cohort Studies 0302 clinical medicine Immunodeficiency Viruses Prednisone Medicine and Health Sciences Outpatient clinic Public and Occupational Health 030212 general & internal medicine Nerves Coinfection lcsh:Public aspects of medicine Peripheral Nervous System Diseases HIV diagnosis and management Middle Aged Vaccination and Immunization Sensory Systems medicine.anatomical_structure Infectious Diseases Somatosensory System Medical Microbiology Peripheral nervous system Viral Pathogens Cohort Viruses Female Leprosy Pathogens Anatomy Brazil medicine.drug Research Article Neglected Tropical Diseases Adult medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine Adolescent lcsh:RC955-962 Anti-HIV Agents 030231 tropical medicine Immunology Antiretroviral Therapy Pain Viral diseases Microbiology 03 medical and health sciences Young Adult Signs and Symptoms Antiviral Therapy Internal medicine Retroviruses medicine Highly-Active Antiretroviral Therapy Humans Peripheral Nerves Microbial Pathogens Neuropathic Pain Aged business.industry Lentivirus Public Health Environmental and Occupational Health Organisms Biology and Life Sciences Pain Sensation HIV lcsh:RA1-1270 medicine.disease Tropical Diseases Diagnostic medicine Peripheral neuropathy Tropical medicine HANSENÍASE Preventive Medicine business Neuroscience |
| Zdroj: | PLoS Neglected Tropical Diseases Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual) Universidade de São Paulo (USP) instacron:USP PLoS Neglected Tropical Diseases, Vol 12, Iss 7, p e0006633 (2018) |
| ISSN: | 1935-2735 1935-2727 |
| Popis: | Background The geographical overlap of HIV (human immunodeficiency virus) and leprosy infection has become increasingly frequent and worrying, bringing many clinical issues. Peripheral neuropathy is very frequent in leprosy because of the predilection of its etiologic agent by Schwann cells of the peripheral nervous system, and it also affects individuals with HIV as one of the most common neurological manifestations. Methodology/Principal findings The present study compared a cohort of 63 patients diagnosed with leprosy and coinfected with HIV with a cohort of 64 patients with leprosy alone, who were followed at the outpatient clinic of the Nucleus of Tropical Medicine of the Federal University of Pará, Brazil. We observed that HIV-coinfected leprosy patients presented greater odds of overall peripheral nerve damage (nerve function impairment—NFI) than patients with leprosy alone. More sensitive damage was observed, especially in patients coinfected with multibacillary forms. Leprosy patients coinfected with HIV presented higher chances of motor damage with improvement over time using multidrug therapy (MDT) and highly active antiretroviral therapy (HAART), along with a greater extent of damage and occurrence of neuritis. The data suggest that in addition to patients presenting possible damage caused by leprosy, they also had a greater damage gradient attributable to HIV disease, but not related to HAART because most of these patients had been on the treatment for less than a year. Neuritis was treated with prednisone at doses recommended by the WHO, and coinfected patients had the highest rate of clinical improvement in the first 60 days. Conclusions/Significance The clinical characteristics of the two diseases should be considered in leprosy patients coinfected with HIV for better diagnosis and treatment of peripheral neuropathy. We suggest that new simplified assessment tools that allow the evaluation of the NFI of these patients be developed for use in the service. Author summary Coinfections of leprosy and HIV are a challenge for clinical management, particularly concerning peripheral neuropathy, which is common in leprosy and is also present in HIV infection. We conducted a clinical follow-up of leprosy patients coinfected with HIV and compared them to patients with leprosy alone and observed that coinfected patients were more likely to present overall peripheral nerve damage (nerve function impairment—NFI), especially in multibacillary patients, where motor damage was largely responsible for this impairment. Throughout the period using multidrug therapy (MDT) and highly active antiretroviral therapy (HAART), the development of the damage, along with the occurrence of neuritis and complaints, decreased considerably. Thus, the data suggest that in addition to patients presenting possible damage caused by leprosy, they also have a greater damage gradient attributable to the disease due to HIV but not related to HAART. Another important point was the therapeutics used for neuritis with prednisone at doses recommended by the WHO, in which the coinfected patients had the highest rate of clinical improvement in the first 60 days. The characteristics of the two diseases should be considered in the understanding and clinical management of peripheral nerve alterations in leprosy patients coinfected with HIV. In addition, it became clear that further NFI assessment tests should be used with these patients. |
| Databáze: | OpenAIRE |
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