Western blot profile in HIV infection.

BACKGROUND: Although the overall sensitivity and specificity of the western blot (WB) test for detection of antibodies to various viral proteins is high, there has been a substantial difference in the timing of the appearance of antibody bands and their intensities during different stages of HIV infection. AIMS: Mapping different band patterns of Western blot results and correlating them with stages of HIV infection. METHODS: We performed a retrospective study with 1,467 HIV-1 infected cases confirmed by WB test between January 2002 to July 2005, with the objective of mapping different band patterns of western blot results and determining whether the presence or absence of certain bands was associated with any specific stage of HIV infection. For the interpretation of the WB results in this study, the guidelines recommended by NACO, India were followed. RESULTS: Reactivity with all the bands was the most commonly observed WB pattern, occurring in 92.91% (1363/1467) of cases, whereas the other 7.09% showed uncommon band patterns. Of all individual bands, p31 band was the most frequently missing one, absent in 7.09% cases. On classifying the WB reactive cases by the WHO clinical staging system, 38.45% (564/1467) were in Stage 1, 47.99% (704/1467) in stages 2 and 3 and 13.56% in stage 4. Correlation of CD4 cell counts with the various uncommon band patterns showed that only 5.56% (4/72) had counts in the 200-500 cells/microl range, whereas 45.83% and 48.61% had counts of < 200 and> 500 cells/microl respectively. CONCLUSION: Interpretation of the WB band pattern in combination with clinical features may be occasionally useful in predicting the stage of HIV infection.

Effect of HIV infection on leprosy: a three-year survey in Bamako, Mali.

From February 1992 until June 1994, all patients with histologically proven leprosy examined at the Leprology Unit of the Institut Marchoux in Bamako, Mali, were screened for HIV serology. In total, 740 leprosy patients have been tested; 553 known, previously treated leprosy cases and 187 new cases, mainly self-reporting and referred cases. The global seroprevalence in the sample was 1.5% (11/740), and increased from 1.3% in 1992 to 3.1% in 1994. HIV seroprevalence was higher in paucibacillary (PB) than in multibacillary (MB) cases (3.8% versus 0.8%, p < 0.05), and was slightly higher in new cases than in known, already treated cases (2.1% versus 1.3%), although not significantly. Among the 553 known, already treated leprosy patients, 1 out of 7 HIV-seropositive patients relapsed, as opposed to 34 out of 546 HIV-seronegative cases (14.2% versus 6.2%, p = 0.36). Among the new cases, none of the 37 patients with reaction and/or neuritis was HIV positive. In known, treated leprosy cases, there was no difference in the frequency of reactions and/or neuritis between HIV-positive and HIV-negative cases. Migration in a neighboring country appeared to be a risk factor for HIV seropositivity in our sample (chi 2 = 4.5, p = 0.04). In order to estimate the association of HIV with leprosy as compared to the general population, a control group of blood donors was set up, matched for age and sex. There was, however, no difference in HIV seroprevalence between the control group (9/735, 1.2%) and the leprosy group (1.5%). Although leprosy patients recruited for this study constitute a highly selected sample, it appears that HIV infection has little effect on leprosy, particularly on the PB/MB ratio, leprosy reactions and neuritis, but there is a suggestion the HIV infection might be associated with increased frequency of relapse.

PIP: HIV infection is a major risk factor for tuberculosis and other mycobacteria, but its association with leprosy remains unclear. From February 1992 to June 1994, all leprosy patients examined at the Leprology Unit of the Institut Marchoux, a reference center for leprosy in Mali, were screened for HIV infection. 740 leprosy patients were tested over the period; 553 known, previously treated cases and 187 newly diagnosed leprosy cases. 584 patients were multibacillary (MB) cases and 156 were paucibacillary (PB), with a large majority of MB cases among the known cases, due to the selected recruitment of those patients. There were 539 men of mean age 39.3 years and 201 women of mean age 37.7. New and known cases were of mean ages 30.7 and 41.6 years. Overall, 1.5% (11/740) were identified as HIV seropositive, increasing from 1.3% in 1992 to 3.1% in 1994. HIV seroprevalence was 3.8% among PB cases and 0.8% among MB cases, and was slightly higher in new cases than in known, already treated cases. Among the 553 known, already treated leprosy cases, 1 out of 7 HIV-seropositive patients relapsed, compared to 34 of 546 HIV-seronegative cases. Among the new cases, none of the 37 patients with reaction and/or neuritis was HIV positive. It appears that HIV infection has little effect upon leprosy, especially upon the PB/MB ratio, leprosy reactions and neuritis, but HIV infection may be associated with increased frequency of relapse.

Human immunodeficiency virus and Treponema pallidum infections in Nigerian patients with leprosy.

Fifty-one patients were selected from 4 leprosaria in eastern Nigeria and were examined for evidence of syphilis. They were screened serologically for treponemal and human immunodeficiency virus (HIV) infections. Information about their sexual behaviour and demographic data were obtained to determine the factors associated with increased risk of contracting sexually transmitted diseases (STD). They were compared with 115 controls. The results showed that positive treponemal tests were more common in those patients living outside the leprosaria (P < 0.05). Age and sex of the patients living inside the leprosaria were not factors associated with treponemal infections. Leprosy appeared to be a factor for T. pallidum infection when compared with the control group (P < 0.05; OR 476; CI 1.16, 19.5). One leprosy patient and one control subject had positive HIV tests and there was no significant association between leprosy and HIV infection. These findings suggest the possibility of the spread of sexually transmitted diseases amongst the leprosy patient population. The importance with respect to control measures is that leprosy patients living outside leprosaria may constitute a potential reservoir for introducing sexually transmitted diseases into the leprosaria.

HIV-1 infection as a risk factor for leprosy; a case-control study in Tanzania.

A case-control study was carried out in Tanzania to determine the relative risk of those with HIV-1 infection for getting leprosy. Cases were 93 consecutively diagnosed patients with leprosy aged 15-54 years from the Mwanza Region. Controls were a representative population sample of 4161 people drawn from a stratified cluster sample from urban areas, roadside settlements, and rural villages. HIV-1 infection was determined by enzyme-linked immunosorbent assay (ELISA); Western blot was used when the ELISA result was indeterminate. The HIV-1 prevalence in leprosy cases was 10% in rural (7 of 72) and in roadside and urban areas (2 of 21); in controls these prevalences were 3.4% and 9.9%, respectively. The relative risk of HIV-1 infection for the development of leprosy was estimated to be 2.2 [95% confidence interval (CI) = 1.0-4.7; p = 0.07]. HIV-1 infection was significantly associated with multibacillary (MB) leprosy (odds ratio 4.6; CI = 1.3-13.2) but not with paucibacillary leprosy (odds ratio 1.4; 95% CI = 0.4-3.8). The population etiological fraction for the development of MB leprosy attributable to HIV-1 infection in this population is estimated to be 13% (95% CI = 4%-23%). We conclude that HIV-1 is a risk factor for the development of MB leprosy. The impact of the HIV-1 epidemic on the incidence of leprosy so far has been limited since HIV-1 occurs mainly in urban areas and leprosy in rural areas.

Sexually transmitted diseases in leprosy patients in north and northeastern India. A futile search for human immunodeficiency virus antibody.

Three-hundred-eighty-four leprosy patients were clinically examined for sexually transmitted diseases (STD) in north and northeastern India, revealing a high incidence (5.2%) of STD among them. Eighteen males, one female, and one eunuch were found to have chancroid ulcer, gonococcal urethritis, lymphogranuloma inguinale, and primary chancre. Of these patients, only 100, selected randomly, could be screened serologically for STD due to Treponema pallidum, herpes simplex (type 1 and 2), Entamoeba histolytica, hepatitis-associated virus, cytomegalovirus, Chlamydia trachomatis and human immunodeficiency virus (HIV); 100 control sera were included for comparison. In addition, sera from another 133 normal subjects and another 176 lepromatous patients were also screened for HIV antibody. Thus, a total of 233 normal sera and 276 leprosy sera were tested for HIV antibody. Although our leprosy patients have shown significantly high incidences of clinical STD and also high seropositivity against T. pallidum, herpes-simplex viruses types 1 and 2, hepatitis-associated virus, and cytomegalovirus, the search for antibody against HIV was negative. Our clinical and serological data suggest promiscuity in our patient population. The absence of HIV antibody in this high-risk population, however, seems to be an enigma.

HIV-I antibodies in health and disease.

Antibodies to human immune deficiency (HIV) virus were studied in 2000 individuals including cases of non-Hodgkin's lymphoma, systemic lupus erythematosus (SLE), leprosy, chronic renal failure on haemodialysis and patients attending STD clinics. A group of blood donors was also screened, ELISA kits provided by Wellcome Diagnostics were used. Results indicate that the ELISA values were far above the cut off figure in all except in a couple where the husband who had stayed in Uganda for several years, and had features of full blown AIDS died 4 months after the diagnosis. The spouse contacted AIDS within a relatively short incubation period and died within 6 months of diagnosis. The North Indian population thus appears to be free of this virus so far. This observation will be an important lead mark in the future epidemiology of HIV infection in India.

Prevalence of HIV infection among patients with leprosy in African countries and Yemen.

Screening for human immunodeficiency viruses types 1 and 2 (HIV-1 and HIV-2) antibodies was carried out in the serum of 1,245 leprous patients and 5,731 controls selected in nine different centers from the Congo, Ivory Coast, Senegal, and Yemen Arab Republic. In Yemen, all sera were negative. In the Congo, the seropositivity among patients and controls was, respectively, 3.8 and 5.2%; in Senegal, it was 1.3 and 0.6%; and in the Ivory Coast 4.8 and 3.9%. Differences were not statistically significant, even considering lepromatous or tuberculoid forms (3.6% and 3.7%, respectively). HIV-2 antibodies were only detected in subjects from the Ivory Coast and Senegal. Using appropriate criteria for seropositivity (confirmation by Western blot, reactivity to HIV envelope glycoproteins) and a large selection of patients (several countries with several centers), it appears that leprosy (and specially the lepromatous form) is not a factor for HIV infection.