The role of human T cell lymphotrophic virus type 1, hepatitis B virus and hepatitis C virus coinfections in leprosy

Leprosy spectrum and outcome is associated with the host immune response against Mycobacterium leprae. The role of coinfections in leprosy patients may be related to a depression of cellular immunity or amplification of inflammatory responses. Leprosy remains endemic in several regions where human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) or hepatitis C virus (HCV) are also endemic. We have evaluated the evidence for the possible role of these viruses in the clinical manifestations and outcomes of leprosy. HTLV-1, HBV and HCV are associated with leprosy in some regions and institutionalization is an important risk factor for these viral coinfections. Some studies show a higher prevalence of viral coinfection in lepromatous cases. Although HBV and HCV coinfection were associated with reversal reaction in one study, there is a lack of information about the consequences of viral coinfections in leprosy. It is not known whether clinical outcomes associated with leprosy, such as development of reactions or relapses could be attributed to a specific viral coinfection. Furthermore, whether the leprosy subtype may influence the progression of the viral coinfection is unknown. All of these important and intriguing questions await prospective studies to definitively establish the actual relationship between these entities.

Transmision perinatal del virus de la inmunodeficiencia humana / Perinatal transmission of the human immunodeficiency virus

Transmission of human immunodeficiency virus (HIV) from an infected mother to her fetus or infant occurs in utero and probably during labor and delivery. Athough the risk seems low, transmission via breast milk can also occur; breast-feeding during the pediod of seroconversión of the mother may carry relatively more risk. Because of the limitations of conventional HIV testing in infants, it is difficult to determine the rate of transmission from an infected mother to her fetus of infant. The transmission rate is probably between 20 percent and 60 percent, depending on the mother's health status. (the rate is higher in women who have more advanced disease.) As HIV spreads worlwide and more women get infected, a growing number of children are acquiring the infection perinatally. Although the actual numbers of pediatric AIDS cases and HIV-infected children are unknown, perinatal HIV infection is a significant problem, particularly in pattern 2 countries where HIV is spread primarily by heterosexual contac. Children in these countries may account for up to 35 percent of all AIDS cases, even though a large proportion of HIV infected children die of common childhood diseases before they develop clinical AIDS. In pattern 1 countries, where HIV is prdominantly affecting homosexual and bisexual men, children are being infected by mothers who have acquired the infection through intravenous drug abuse or