EFFECT OF HIV-INFECTION ON LEPROSY - A 3-YEAR SURVEY IN BAMAKO, MALI

From February 1992 until June 1994, all patients with histologically p roven leprosy examined at the Leprology Unit of the Institut Marchoux in Bamako, Mall, were screened for HIV serology. In total, 740 leprosy patients have been tested; 553 known, previously treated leprosy case s and 187 new cases, mainly self-reporting and referred cases. The glo bal 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 paucib acillary (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 tr eated cases (2.1% versus 1.3%), although not significantly. Among the 553 known, already treated leprosy patients, 1 out of 7 HIV-seropositi ve patients relapsed, as opposed to 34 out of 546 HIV-seronegative cas es (14.2% versus 6.2%, p 0.36). Among the new cases, none of the 37 pa tients with reaction and/or neuritis was HIV positive. In known, treat ed leprosy cases, there was no difference in the frequency of reaction s and/or neuritis between HIV-positive and HIV-negative cases. Migrati on in a neighboring country appeared to be a risk factor for HIV serop ositivity 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 popula tion, a control group of blood donors was set up, matched for age and sex. There was, however, no difference in HIV seroprevalence between t he 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, p articularly on the PB/MB ratio, leprosy reactions and neuritis, but th ere is a suggestion the HIV infection might be associated with increas ed frequency of relapse.