Link between antiretrovirals, leprosy probable

Increased access to antiretroviral drugs in developing countries has revealed a "startling and worrisome side effect" by exposing "hidden leprosy infection" in some HIV-positive people receiving antiretrovirals, the New York Times reports.

According to experts, antiretrovirals help rebuild the immune system, which then produces new white blood cells that carry bacteria from dormant leprosy infections to the skin of the face, hands and feet.

Experts say that in Brazil and India, as well as in African and Caribbean countries and elsewhere, some HIV-positive people taking antiretrovirals have developed facial ulcers and have lost feeling in their fingers and toes.

Roughly 12 such cases have been reported in medical literature since 2003, according to the Times.

Experts say such cases are likely to increase in the developing world, where 300,000 new leprosy cases were reported last year and 38 million people are living with HIV.

Gilla Kaplan, a professor at the University of Medicine and Dentistry of New Jersey, said antiretroviral therapy is "going to flush out the silent leprosy by making it symptomatic."

According to Pierre Couppie -- chief of dermatology at the Central Hospital in Cayenne, French Guiana -- roughly one in 500 people living with AIDS in the country will develop leprosy lesions after beginning antiretroviral treatment.

Experts are most concerned about India, which has recorded 5.2 million HIV cases and at one point was home to 70% of the world's leprosy cases, according to the Times.

Other countries with high leprosy prevalence include Madagascar, Mozambique, Myanmar and Nepal.

According to experts, a leprosy pandemic or high numbers of leprosy-related deaths likely will not occur because the disease can be treated with antibiotics that are provided at no cost by Novartis.

Denis Daumerie, who heads the World Health Organization's efforts to combat leprosy, said, "It's not a matter of concern for public health.

It's a matter of concern for the individual patients."

Treatment for the disease involves taking several pills for six months to two years, which can be "an added burden" for people living with HIV/AIDS who typically take three pills daily, according to the Times.

In addition, because little is known about HIV and leprosy coinfection, it might take weeks for doctors to diagnose leprosy in HIV-positive people (McNeil, New York Times, 10/24).