Management of HIV infected patients with active Buruli ulcer in tropical regions, a new therapeutic challenge: A review

Abstract

Buruli ulcer (BU) is endemic in tropical and sub-tropical regions of sub-Saharan Africa, Asia, Australia, South America and the pacific mainly with high prevalence in West Africa. There is an increasing recognition of BU/HIV co-infection as an important challenge for treatment of Mycobacterium ulcerans disease, mainly in tropical regions. Because of its difficult management, BU/HIV co-infection due to IRIS or paradoxical reactions occurrence, and based on Tuberculosis/HIV co-infection management experience, at the initiative of WHO, some expert issued a preliminary guide to manage BU/HIV co-infection. We conducted a literature review based on current scientific articles and practice experiences to summarize information and guidance principles to make these following suggestions to health care practitioner: Before commencing BU treatment and before starting ART, all HIV/MU co-infected patients should be actively screened for tuberculosis. BU treatment should be commenced before commencing ART and provided for 8 weeks duration. And for the common sense, based on TB management experience HIV, TB and BU control programs should work together in a cooperative framework, mainly in tropical and subtropical regions where the prevalence of these 3 diseases seems high. As, HIV/BU co-infection is increasing in tropical regions, more study should be initiated to determine the cumulative effect of IRIS and paradoxical reactions in BU/HIV co-infected patients on ART and anti-mycobacterial agents, in order to set up recommendation as it was done in TB/HIV co-infection for proper management.