(LML) Polyarthralgia Syndrome 4 years after starting treatment for HIV of a patient with a history of leprosy

Note from the LML editor for those checking our LML blog: "If one is not able to receive our messages directly, please check one’s Spam folder (Junk or Trash folder), remove the blockage to not to consider our email address as Spam".       Leprosy Mailing List – March 4,  2017   Ref.:    (LML)  Polyarthralgia Syndrome 4 years after starting treatment for HIV of  a patient with a history of leprosy   From:  Arry Pongtiku, Papua, Indonesia   Dear Pieter,

I would like to try to  comment and share our experience from Papua regarding above mentioned topic introduced by Dr Gianfranco Barabino regarding Polyarthralgia Syndrome for Co infection Leprosy-HIV (LML, February 28, 2017) and reacted on by Dr. Ben Naafs (LML, March 1, 2017).

 

I lived and worked in West Papua, Indonesia, where the prevalences of leprosy, TB, HIV and other tropical diseases were high. Not infrequently we found co-infections such Leprosy-TB, Leprosy-HIV, and Leprosy-TB- HIV; leprosy - lymphatic filariasis. Well-known of Papua is the high prevalence of Sulfa/sulphone allergy  (like DDS allergy in leprosy) and cases of Sulphone /cotrimoxazole allergy in AIDS patients.

 

I could say "Leprosy is challenging and interesting due to its complexity and  it opens a broad spectrum of mind when we talk about  leprosy reaction, co-infection and rehabilitation/stigma". Dr Richard de Soldenhoff (former NLR technical adviser/expert) advised me not only to pay attention to leprosy but also to keep updated about HIV.  Dr Revankar (former adviser WHO Indonesia)  advised me similarly regarding co-infections of leprosy. I assume that there is not much information or guidance regarding leprosy and HIV co-infection, and  as such difficult to answer Dr Barabino's question.

I agree with dr Ben Naafs that M.leprae bacilli take some years to disappear from the body of the patient. Therefore, we use the terminology RFT (Release From Treatment - finishing MDT) and RFC (Release From Control). There is need to observe the patients after RFT for some years, because of  possible reactions, wound problems or  social problems to happen.

I guess that the case reported by Dr Barabino was a HIV patient with a  leprosy reaction. I would like to share  that we have handled about 6 cases (Leprosy and HIV with poly-arthralgia) from the field and succeeded . They had characteristics: on treatment ARV (Anti Retro Viral), history of leprosy (RFT some years), could not walk and having pain in joints (polyarthralgia).  Carefully examined if they had nodules, proved by touching and sweeping with hand. We did not have any guidance how to handle such cases. However, we managed those patients succesfully. For polyarthralgia syndrome we used prednisolone started with 40 mg and tapering off every 5-7 days (shorter than common regiment of prednisolone). We also gave extra amoxicilline 500 mg 3x1 (5-7 days). ARV was not stopped. Nutrition, rest and other trigger factors must be considered. Note: giving steroid for AIDS patients must be done carefully and under close supervision, some doctors do not like giving steroids to AIDS patients.

Immuno-compromised recovery syndrome (IRIS) in AIDS patient usually happened after introducing ARV; patient looks very sick. Polyarthralgia syndrome is a different issue.

 

In Papua we offer anybody who come to health center and hospital to test for HIV. If people get leprosy reaction or something unusual we always ask the people to be tested for HIV. 

 

Thank you very much,

salam,

 

Arry Pongtiku, Papua, Indonesia

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com

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