Persistência de anticorpos antifosfolipídeos na hanseníase: fatores epidemiológicos, clínicos e imunológicos associados

Abstract

Antiphospholipid (aPL) antibodies may be detected during the course of many infections, but are usually transient. In leprosy, however, these antibodies are found to linger for longer periods. The aim of this study was to evaluate the persistence of anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) antibodies in leprosy patients, and disclose epidemiologic, immunologic and clinical features associated with it. Thirty-eight APL antibody positive leprosy patients completed polychemotherapy and were followed for an average of 66,9 months, when a second sample was drawn for a new aPL testing. Enzima -linked immunosorbent assay (ELISA) was used to measure aCL and anti-β2GPI antibodies. Epidemiologic and clinical data were analyzed with logistic regression. Persistence of aPL antibodies was demonstrated in 32 out of 38 leprosy patients thoroughly treated and considered cured, studied after an average of 66,9 months of follow up. All of these sera were IgM isotype. Sixteen of these patients (50%) presented lepromatous clinical form. Reactional state was present in three patients (9,4%). Seventeen (53,1%) were in use of prednisone and/or thalidomide. Observed median values of aPL antibodies were rather high (64U/mL for aCL and 62U/mL for aβ2GP). Occurrence of vascular thrombosis, gestational morbidity, diabetes, tobacco use and alcoholism were not different in positive and negative aPL patients. Logistic regression showed significant association of aPL antibodies persistence and age (p=0,045, OR=0,91 e IC 95% 0,82 - 1,00), lepromatous clinical form (p=0,034; OR=0,02 e IC 95% = 0,0 - 0,76) and bacillary index (p=0,044; OR=2,74 e IC 95% = 1,03 – 7,33). aPL antibodies in leprosy patients do persist many years after treatment. Patients’ age, lepromatous clinical form and bacillary index were factors that influence persistence. No thromboembolic events were registred.