HIV-1 SUBTYPES AND IMMUNOLOGICAL CHARACTERISTICS AMONG A COHORT OF HIV+/AIDS PATIENTS CO-INFECTED WITH MYCOBACTERIUM LEPRAE

PEREIRA, G. A. S.; ARAÚJO FILHO, J. A.; STEFANI, G. P.; SOUZA, L. C. S. & STEFANI, M. M. A.
Instituto de Patologia Tropical e Saúde Pública – UFG

gisner@terra.com.br ; mstefani@iptsp.ufg.br

HIV, M. leprae, co-infection, diversity

INTRODUCTION

An important consequence of Human Immunodeficiency Virus 1 (HIV-1) infection is the higher susceptibility to opportunistic mycobacterial infections, especially with Mycobacterium avium complex (MAC) and Mycobacterium tuberculosis, both correlated to increased morbidity and mortality.

Cellular immunity mediated by CD4+ T Lymphocytes constitutes the most important protective mechanism for both HIV and Mycobacterium leprae.

Since the description of AIDS pandemic, HIV has spread through tropical and subtropical areas endemic for M. leprae infection, such as in Brazil and in many African countries, allowing the investigation of possible adverse interactive effects.

The aim of this study was to describe the immunological, virological and histopathological characteristics of HIV-1 patients co-infected with M. leprae.

MATERIAL AND METHODS

Patients: 22 HIV/AIDS – M. leprae co-infected patients recruited at the main reference center HAA - Goiânia-GO from 1997-2000.

Blood-EDTA: HIV-1 subtypes – Heteroduplexes Mobility Assay for env and gag regions; second round primers ES7/ES8 and H1gag1584/g17 respectively.

Skin biopsies (4mm): histopathology – HE and Ridley-Jopling classification criteria – Fite Faraco staining.

Immunostaining – deparaffinized tissue sections, wet heating antigen retrieval; Primary antibodies CD68, CD57, CD3, CD4, CD8; Isotype specific secondary biotinilated antibodies; Avidin-biotin peroxidase complex; Diaminobenzidine (DAB).

IgM antibodies specific to M leprae phenolic glycolipid I (PGL-I) were assayed by ELISA.

RESULTS

Principal characteristics of the cohort of patients co-infected with HIV-M. leprae (n=34) diagnosed within 1991-2001.

Median age (range) 38 (22-58 years)

Men / Women 24 / 10

PB / MB Leprosy 20 / 14

HIV+ / aids 2 / 32

First diagnosis

HIV 13

Leprosy 9

Simultaneous 10

NA 2

Immunological and virological profile and histopathological characteristics of skin biopsies of HIV/M. leprae co-infected patients

Immunological and virological profile and histopathological characteristics of skin biopsies of HIV/M. leprae co-infected patients (cont.)

CONCLUSIONS

HIV-1 subtype B is clearly predominant in this cohort followed by subtype F.

HIV-1-/M. leprae co-infected patients which reported type 1 reaction following HAART may be presented immune reconstitution inflammatory syndrome.

Immunological, virological and histopathological profiles point out to lack of impact of one disease over the other.

None HIV-1-/M. leprae co-infected patients were seropositive for PGL-I Þ in leprosy patients, IgM antibody titers are considered surrogate markers of the bacillary load.

HIV/AIDS – M. leprae co-infection deserves continued investigation specially in immuno-reconstituted patients submitted to HAART.

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CNPq # 400183/99; FUNAPE; CN DST-AIDS