|Year : 2000 | Volume
| Issue : 1 | Page : 39-40
Leprosy with HIV infection in Manipur
Th. Nabakumar Singh, Th. Nandakishore, Loken Singh
Th. Nabakumar Singh
A 27 -year -old unmarried male presented with typical clinical features of lepromatous leprosy which was confirmed by slit-skin smear and histopathological examinations. He also had history of intravenous use of heroin and tested positive for HIV-I antibody by ELISA and Western blot. This is the first case report of co-infection of leprosy and HIV from Manipur.
|How to cite this article:|
Singh TN, Nandakishore T, Singh L. Leprosy with HIV infection in Manipur.Indian J Dermatol Venereol Leprol 2000;66:39-40
|How to cite this URL:|
Singh TN, Nandakishore T, Singh L. Leprosy with HIV infection in Manipur. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Dec 13 ];66:39-40
Available from: http://www.ijdvl.com/text.asp?2000/66/1/39/4863
Pulmonary or extra- pulmonary tuberculosis and other atypical mycobacterioses e.g. Mycobacterium aviumcomplex are very common in HIV infected individuals. But reports of co-infection of leprosy and HIV in India are few. The seroprevalence of HIV infection in Manipur is very high, about 72% is accounted by intravenous drug users. We report the first case of co-infection of leprosy and HIV from Manipur.
A 27 - year - old unmarried male farmer from a hilly district of Manipur presented with complaints of multiple, asymptomatic nodules on the face, ears, trunk and extremities of 2 years duration. He gave a history of intravenous use of heroin (also locally called No.4) 8 years back associated with the sharing of syringes and needles for about 2 years. He had no history of sexual contact. Cutaneous examination revealed multiple, symmetrical, erythematous small plaques on back and extremities and shiny nodules on both the ears, face, buttocks, trunk and extremities, diffuse infiltration of face and both external ears. The nodules were few mm to 2cm in size. Some of the plaques on the extremities showed ulceration and scaling while most of the other lesions were normoaesthetic. There was significant thickening of both ulnar and lateral popliteal nerves with mild tenderness but the other peripheral nerves were unremarkable. Slit-skin smear examination for AFB from 6 different sites including normal looking skin showed positive with B.I.of 4+ to 6+ and skin biopsy from back showed histopathological features consistent with lepromatous Leprosy. Testing of blood for HIV anti-bodies by 2 different kits was reactive and was further confirmed by positive Western blot. Routine investigations like complete hemogram, urine, stool, liver function test (LFT) and X-ray chest were normal. Hepatitis B surface antigen (HBsAg) and VDRL were negative. CD 4 count was not done due to lack of facilities. Other systemic examinations were normal.
Association between tuberculosis and HIV infection is well established.  However, various studies to determine the relationship of leprosy with HIV infection regarding the risk factor, type of clinical presentation, treatment response, rate of reaction and relapse give conflicting results. Most of the studies show no evidence of any direct correlation of leprosy with HIV infection. A study in Malawi in 1991 showed no evidence for an association between leprosy and HIV infection except that among leprosy relapses 16.7% (2/12) were HIV positive.  Some authors opined that HIV infection did not much influence paucibacillary or multibacillary type of leprosy in patients including leprosy reactions and neuritis.  On the other hand, Borgdorff et al found HIV-I infection to be significantly associated with multibacillary type of leprosy in a study done in Tanzania. 
Tissue cell-mediated immune response against Mycobacterium leprae is known to be preserved even though the peripheral blood lymphocyte count (CD4) was reduced in concurrent leprosy and HIV infected patients irrespective of the stage of the HIV infection. Our patient also had lepromatous leprosy with HIV infection. As Manipur has a high seropositivity rate of HIV infection and relatively a low prevalence of leprosy, (2.41 per ten thousand population as on I st July 1998), this case could be a simple co- incidence. Since ethnic differences are also known to influence the occurrence and type of leprosy even,  the various relationship of HIV infection in leprosy patients of our population which is predominantly of Tibeto_ Mongoloid could only be estimated by taking up larger number of leprosy cases, HIV seropositivity testing and long term followup studies to understand the influence of HIV infection on leprosy
|1||Epidemiological analysis of HIV/AIDS in Manipur, Mnipur State AIDS Control Society, Government of Mnipur, October 1998.|
|2||Elliot AM, Luo N, Tempo G, et al. Impact of HIV on tuberculosis in Zambia: a cross sectional study. Br Med J 1990 ; 301: 412-415.|
|3||Ponnighaus JM, Mwanjasi, Fine PEM, et al. Is HIV infection a risk factor in leprosy. Int J Lepr 1991 ; 59 ; 221 - 228.|
|4||Lienhard C, Kamate B, Jamet P, et al. Effect of HIV infection on leprosy: a three-year survey in Bamako; Mali Int J lepr Other Mycobact Dis 1996 ; 64 ; 383 - 391.|
|5||Borgdorff MV,Brock 3 Vanden, Chum HS, et al. HIV infection as a risk factor for leprosy, a case control study in Tanzania. Int J Lepr 1993; 61; 556-562.|
|6||Sampaio EP, Caneshi JR, Nervy JA, et al. Cellular immune response to Mycobaterium leprae infection in human immunodeficiency virusinfected individuals. Infect Immun 1995; 63; 1848 - 1854.|
|7||Noorden SK. The epidemiology of leprosy, in: Leprosy -Edited by Hastings R C. Churchill Livingstone, Edinburgh, Second Edition 1994; 33 - 34.|