Demographic, clinical and laboratory characteristics in a cohort of leprosy patients according to the presence or absence of viral co-infection.

<p>¹ Three subjects had HIV & HTLV-1 coinfection, 1 had HIV & HBV, and 1 had HBV and HCV</p><p>² Indeterminate (I), pure neural (N), tuberculoid (TT), borderline-tuberculoid (BT), borderline-borderline (BB), borderline-lepromatous (BL), lepromatous (LL)</p><p>³ BI, bacillary index</p><p>* Fisher’s exact test</p><p>** Unpaired t test</p><p>Ŧ Comparison between the group without co-infection and the group with co-infection</p><p># Comparison between the group HTLV-1 co-infection and the group without co-infection</p><p>## Comparison between the group HBV co-infection and the group without co-infection</p><p>### Comparison between the group HCV co-infection and the group without co-infection</p><p>Demographic, clinical and laboratory characteristics in a cohort of leprosy patients according to the presence or absence of viral co-infection.</p

Probability of being free of developing reactions or neuritis during and after multidrug therapy.

<p>Probability of being free of developing reactions or neuritis during and after multidrug therapy.</p

Viral Co-infection and Leprosy Outcomes: A Cohort Study

<div><p>Background</p><p>The role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses.</p><p>Methodology/Principal Findings</p><p>Cohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02–18.74.</p><p>Conclusions/Significance</p><p>Leprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients.</p></div

Clinical outcomes in a cohort of leprosy patients according to the presence or absence of viral co-infection.

<p>¹ NFI: nerve function impairment</p><p>² Associated with reaction or neuritis</p><p>³ Reactions, neuritis or silent neuropathy</p><p>* Fisher’s exact test</p><p>Ŧ Comparison between the group without co-infection and the group with co-infection</p><p># Comparison between the group HTLV-1 co-infection and the group without co-infection</p><p>## Comparison between the group HBV co-infection and the group without co-infection</p><p>Clinical outcomes in a cohort of leprosy patients according to the presence or absence of viral co-infection.</p

Criteria for study inclusion or exclusion.

Criteria for study inclusion or exclusion.</p

Frequencies of type 1 reaction, type 2 reaction, type 1 plus type 2 and neuritis among co-infected and not co-infected leprosy patients.

<p>Frequencies of type 1 reaction, type 2 reaction, type 1 plus type 2 and neuritis among co-infected and not co-infected leprosy patients.</p

Summary of human incidence studies for dengue virus in the Middle East and North Africa (n = 3).

<p>Summary of human incidence studies for dengue virus in the Middle East and North Africa (n = 3).</p

Summary of human prevalence studies for dengue virus in the Middle East and North Africa (n = 103).^*

<p>Summary of human prevalence studies for dengue virus in the Middle East and North Africa (n = 103).^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005194#t004fn001" target="_blank">*</a>}</p

Number of individuals according to each parameter used for calculation of ELISA test performance.

Number of individuals according to each parameter used for calculation of ELISA test performance.</p

Geographic distribution of human prevalence studies and reported outbreaks of dengue in the Middle East and North Africa.

Geographic distribution of human prevalence studies and reported outbreaks of dengue in the Middle East and North Africa.</p