Human Immunodeficiency Virus and Leprosy Coinfection

We report eight cases and the incidence of leprosy in human immunodeficiency virus (HIV)-infected individuals after initiation of antiretroviral treatment (ART). The incidence of leprosy in patients on ART was 5.22 per 1,000 person-years (95 % confidence interval, 2.25 to 10.28). This high incidence suggests that there should be regular examination of HIV-infected individuals for clinical signs of leprosy. Although there is a declining trend in the global burden of leprosy, there are 15 countries in Asia and Africa which ac-count for 94 % of the global total of the new-case detection rate. India is one of the countries where 1,000 new cases of leprosy were reported during 2006 (14). Human immunodefi-ciency virus (HIV) and leprosy both are feared due to the associated social stigma, and leprosy can manifest as immune reconstitution inflammatory syndrome (IRIS) in HIV-infected individuals (9). The first case of leprosy-associated immune reconstitution disease was reported in 2003 for a Ugandan living in London, United Kingdom (5). Later leprosy was de-scribed as a manifestation of IRIS in many instances (8, 10). Antiretroviral treatment (ART) for HIV infection is now available in resource-poor regions where leprosy is still en-demic, such as South America, Africa, and Asia, including India. India accounts for half of the world’s leprosy cases due to its population of more than 1 billion, even though a nation-wide prevalence of less than 1 case/10,000 population was reported in 2005 (4). In addition, India also has the third largest burden of HIV-infected individuals (12). In spite of having a large burden of both leprosy and HIV, there are very few published reports of HIV-leprosy coinfection from India. We report eight cases of incident leprosy in HIV-infected patients who were on ART and the incidence of leprosy in HIV-infected individuals on ART