- Volume 62 , Number 4
- Page: 611–2
Dr. Ponnighaus replies
To the Editor:
The comments by Dr. Gormus are most welcome. However, I would like to emphasize that we did not observe any evidence of an association between incident leprosy and HIV infection in northern Malawi (6). In the whole of Malawi detection rates continue to decline as shown in The Table while disability and lepromatous ratios are stable, although HIV infection rates are known to be on the increase. This observation also argues against the likelihood of "an increase in leprosy cases worldwide secondary to the AIDS epidemic."
The authors' conclusion in a recent study from Tanzania indeed suggests that the HIV epidemic may lead to an increase in the number of multibacillary cases (2). However, this conclusion hinges on a single (!) slit-skin smear-negative, "multibacillary," HIV-seropositive leprosy patient and should, at this stage, not be given more credence than it is worth.
We did suggest that there might be an association between HIV infection and relapses (6). Indeed, it would be surprising if the clinical course of leprosy would never be changed by co-infection with the HIV (3). However, given that relapse rates after multidrug therapy seem to be extremely low (4,5), even a moderate increase due to HIV infection would not change the nearly worldwide pattern of declining leprosy detection rates (4).
The relevance of the Gormus, et al. and Baskin, et al. findings (based on three out of five rhesus monkeys) thus still awaits confirmation. But time will tell.
- Jorg M. Ponnighaus,
Dr. Med., D.T.P.H.
Universitats-Hautklinik
66421 Homburg, Saar, Germany
REFERENCES
1. BOERRIGTER, G., PONNIGHAUS, J. M., FINE, P. E. M. and WILSON, R. J. Four-year follow-up results of a WHO-recommended multiple drug regimen in paucibacillary leprosy patients in Malawi. Int. J. Lepr. 59(1991)255-261.
2. BORGDORFF, M. W., VAN DEN BROEK, J., CHUM, H. J., KLOKKE, A. N., GRAF, P., BARONGO, L. R. and NEWELL, J. N. HIV-1 infection as a risk factor for leprosy; a case-control study in Tanzania. Int. J. Lepr. 61(1993)556-562.
3. BWIRE, R. and KAWUMA, H. J. S. Type 1 reactions in leprosy, neuritis and steroid therapy: the impact of the human immunodeficiency virus. Trans. R. Soc. Trop. Med. Hyg. 88(1994)315-316.
4. FINE, P. E. M. Reflections on the elimination of leprosy. (Editorial) Int. J. Lepr. 60(1992)71-80.
5. PONNIGHAUS, J. M. and BOERRIGTER, G. Are 18 doses of WHO/MDT sufficient for multibacillary leprosy -results of a trial in Malawi. Int. J. Lepr. (in press)
6. PONNIGHAUS, J. M., MWANJASI, L. J., FINE, P. E. M., SHAW, M.-A., TURNER, A. C , OXBORROW, S. M., LUCAS, S. B., JENKINS, P. A., STERNE, J. A. C. and BLISS, L. Is HIV infection a risk factor for leprosy? Int. J. Lepr. 59(1991)221-228.