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Immune reconstitution inflammatory syndrome in leprosy
S Sanghi1, R S Grewal, B Vasudevan
1Department of Dermatology, Command Hospital, Wanowrie, Pune-411040, India.
Indian Journal of Leprosy
|October 7, 2011
Summary
Immune reconstitution inflammatory syndrome (IRIS) can worsen leprosy in HIV patients on antiretroviral therapy. Understanding this paradoxical reaction is crucial as its incidence is expected to rise with increased treatment access.
Area of Science:
- Infectious Diseases
- Immunology
- Dermatology
Background:
- Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) can paradoxically worsen opportunistic infections.
- Immune reconstitution inflammatory syndrome (IRIS) in leprosy presents as unmasking of disease or an inflammatory reaction due to immune system recovery.
- IRIS in leprosy is increasingly recognized, but lacks universal diagnostic criteria.
Purpose of the Study:
- To review the current understanding of IRIS in leprosy.
- To highlight the clinical presentation and management of IRIS in HIV-infected individuals with leprosy.
- To emphasize the growing importance of recognizing IRIS in leprosy due to expanding HAART access.
Main Methods:
- Literature review of reported cases and clinical observations of IRIS in leprosy.
- Analysis of the pathophysiology of immune dysregulation in HIV and leprosy co-infection.
- Synthesis of current treatment strategies for IRIS episodes.
Main Results:
- Approximately 47 confirmed cases of leprosy-associated IRIS reported since 2003, primarily from Brazil and India.
- IRIS manifestations include unmasking of leprosy or inflammatory reactions during HAART initiation.
- Anti-inflammatory drugs and corticosteroids are the mainstay of treatment, alongside continued HAART.
Conclusions:
- IRIS in leprosy is a significant clinical entity in HIV-positive patients undergoing HAART.
- Increased HAART accessibility is likely to lead to a higher incidence of IRIS in leprosy.
- Further research is needed to establish standardized diagnostic criteria and optimize management strategies.
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