{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:28Z","timestamp":1782841648723,"version":"3.54.5"},"reference-count":57,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:00:00Z","timestamp":1758931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Amazon Foundation to Support Studies and Research"},{"DOI":"10.13039\/501100001807","name":"S\u00e3o Paulo Research Foundation","doi-asserted-by":"crossref","award":["#2014\/50315-0"],"award-info":[{"award-number":["#2014\/50315-0"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Leprosy remains a significant public health issue, particularly due to its neuropathic consequences, which affect sensory, motor, and autonomic functions, leading to severe disabilities. HIV\/AIDS, another major public health concern, overlaps geographically with leprosy and is also associated with peripheral neuropathies, complicating the management of co-infected patients. Understanding how Nerve Growth Factor (NGF) is regulated in leprosy and HIV-leprosy co-infection may contribute to immunomodulatory treatments and neuroimmune response control. A cross-sectional study evaluated NGF tissue expression using immunohistochemistry in 47 HIV\/leprosy co-infected patients and 61 leprosy-only patients. The co-infected group had a higher incidence of neuritis (40.4%) and a prevalence of exclusively reversal reactions. However, the occurrence of neuritis was not associated with higher expression of NGF in the tissue. Leprosy reactions were more prevalent in non-co-infected patients with multibacillary forms (50%). Multibacillary forms in both groups of patients showed higher cellular expression of NGF, with a greater tendency for higher NGF expression in non-co-infected multibacillary patients (p = 0.0021), suggesting impairment in the immune response involved in the tissue expression of neurotrophins in the co-infected group. Overall, co-infection with HIV did not influence the increase in NGF in the lesions of leprosy patients compared with patients with leprosy alone.<\/jats:p>","DOI":"10.3390\/microorganisms13102271","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T10:49:34Z","timestamp":1759142974000},"page":"2271","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tissue Expression of NGF in Skin Lesions of HIV-Coinfected and Non-Coinfected Leprosy Patients and Its Relationship with Leprosy Neural Damage"],"prefix":"10.3390","volume":"13","author":[{"given":"Mar\u00edlia Brasil","family":"Xavier","sequence":"first","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine, Federal University of Par\u00e1, Bel\u00e9m 66055-240, Brazil"},{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School, S\u00e3o Paulo University, S\u00e3o Paulo 01246-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0588-4461","authenticated-orcid":false,"given":"Lucas dos Santos","family":"Fontes","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine, Federal University of Par\u00e1, Bel\u00e9m 66055-240, Brazil"},{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School, S\u00e3o Paulo University, S\u00e3o Paulo 01246-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Garcia Borges do","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine, Federal University of Par\u00e1, Bel\u00e9m 66055-240, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone Rodrigues dos","family":"Passos","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine, Federal University of Par\u00e1, Bel\u00e9m 66055-240, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-3552","authenticated-orcid":false,"given":"D\u00e9bora Pinheiro","family":"Xavier","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine, Federal University of Par\u00e1, Bel\u00e9m 66055-240, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa dos Santos","family":"Alcantara","sequence":"additional","affiliation":[{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School, S\u00e3o Paulo University, S\u00e3o Paulo 01246-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elza Ba\u00eda de","family":"Brito","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine, Federal University of Par\u00e1, Bel\u00e9m 66055-240, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9909-9466","authenticated-orcid":false,"given":"Cl\u00e1udia Maria de Castro","family":"Gomes","sequence":"additional","affiliation":[{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School, S\u00e3o Paulo University, S\u00e3o Paulo 01246-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Eduardo Pereira","family":"Corbett","sequence":"additional","affiliation":[{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School, S\u00e3o Paulo University, S\u00e3o Paulo 01246-903, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,27]]},"reference":[{"key":"ref_1","first-page":"255","article-title":"Classification of leprosy according to immunity. A five-group system","volume":"34","author":"Ridley","year":"1966","journal-title":"Int. J. Lepr. Other Mycobact. Dis."},{"key":"ref_2","first-page":"451","article-title":"Histological classification and the immunological spectrum of leprosy","volume":"51","author":"Ridley","year":"1974","journal-title":"Bull. World Health Organ."},{"key":"ref_3","unstructured":"WHO (2025, February 05). Towards Zero Leprosy. Global Leprosy (Hansen\u2019s Disease) Strategy 2021\u20132023, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789290228509."},{"key":"ref_4","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2025, February 06). Secretaria de Vigil\u00e2ncia em Sa\u00fade. Departamento de Doen\u00e7as Cr\u00f4nicas e Infec\u00e7\u00f5es Sexualmente Transmiss\u00edveis. Protocolo Cl\u00ednico e Diretrizes Terap\u00eauticas da Hansen\u00edase. Bras\u00edlia\u2014DF, Available online: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/protocolo_clinico_diretrizes_terapeuticas_hanseniase.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1086\/524688","article-title":"Toll-like receptor 2 (TLR2) polymorphisms are associated with reversal reaction in leprosy","volume":"197","author":"Bochud","year":"2008","journal-title":"J. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1093\/infdis\/jiu612","article-title":"Transcriptional changes that characterize the immune reactions of leprosy","volume":"211","author":"Dupnik","year":"2015","journal-title":"J. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.abd.2019.07.001","article-title":"Disabilities in leprosy: An open, retrospective analyses of institutional records","volume":"95","author":"Rathod","year":"2020","journal-title":"An. Bras. Dermatol."},{"key":"ref_8","unstructured":"WHO (2025, February 12). Leprosy Management of Reactions and Prevention of Disabilities, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789290227595."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e200075","DOI":"10.1590\/0074-02760200075","article-title":"Effect of Mycobacterium leprae on neurotrophins expression in human Schwann cells and mouse sciatic nerves","volume":"115","author":"Nogueira","year":"2020","journal-title":"Mem. Inst. Oswaldo. Cruz."},{"key":"ref_10","unstructured":"UNAIDS (2025, February 12). Joint United Nations Programme on HIV\/AIDS. Global HIV & AIDS Statistics\u2014Fact Sheet. Available online: https:\/\/www.unaids.org\/en\/resources\/fact-sheet."},{"key":"ref_11","unstructured":"WHO (2025, February 12). Global AIDS Strategy 2021\u20132026 End Inequalities. End AIDS, Available online: https:\/\/www.unaids.org\/en\/resources\/documents\/2021\/2021-2026-global-AIDS-strategy."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1046\/j.1529-8027.2001.006001008.x","article-title":"Epidemiology and clinical features of HIV-1 associated neuropathies","volume":"6","author":"Verma","year":"2001","journal-title":"J. Peripher. Nerv. Syst."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/B978-0-444-52902-2.00029-1","article-title":"HIV peripheral neuropathy","volume":"115","author":"Gabbai","year":"2013","journal-title":"Handb. Clin. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"311","DOI":"10.17712\/nsj.2017.4.20160606","article-title":"Neurological manifestations, laboratory and neuroimaging features in HIV-infected patients","volume":"22","author":"Chen","year":"2017","journal-title":"Neurosciences"},{"key":"ref_15","unstructured":"Xavier, M.B. (2006). Estudo Cl\u00ednico e Imunopatol\u00f3gico em Pacientes Coinfectados pelo V\u00edrus da Imunodefici\u00eancia Humana. [Ph.D. Thesis, Federal University of Par\u00e1]. Available online: http:\/\/www.bibcentral.ufpa.br\/arquivos\/145000\/146600\/19_146659.htm."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pires, C.A., Juc\u00e1 Neto, F.O., de Albuquerque, N.C., Macedo, G.M., Batista Kde, N., and Xavier, M.B. (2015). Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003818"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.actatropica.2017.05.010","article-title":"Expression of interleukin-1\u03b2 and interleukin-6 in leprosy reactions in patients with human immunodeficiency virus coinfection","volume":"172","author":"Pires","year":"2017","journal-title":"Acta Trop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1086\/344446","article-title":"Borderline tuberculoid leprosy: An immune reconstitution phenomenon in a human immunodeficiency virus-infected person","volume":"36","author":"Lawn","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.trstmh.2008.06.003","article-title":"Leprosy occurring as immune reconstitution syndrome","volume":"102","author":"Deps","year":"2008","journal-title":"Trans R Soc Trop Med Hyg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1177\/003335490812300213","article-title":"HIV-M. leprae interaction: Can HAART modify the course of leprosy?","volume":"123","author":"Sarno","year":"2008","journal-title":"Public Health Rep."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mouchard, A., Blaizot, R., Graille, J., Couppi\u00e9, P., and Bertin, C. (2022). Leprosy as immune reconstitution inflammatory syndrome in patients living with HIV: Description of French Guiana\u2019s cases over 20 years and systematic review of the literature. PLoS Negl. Trop. Dis., 16.","DOI":"10.1371\/journal.pntd.0010239"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xavier, M.B., do Nascimento, M.G.B., Batista, K.N.M., Somensi, D.N., Juca Neto, F.O.M., Carneiro, T.X., Gomes, C.M.C., and Corbett, C.E.P. (2018). Peripheral nerve abnormality in HIV leprosy patients. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006633"},{"key":"ref_23","unstructured":"Ac\u00e1cio, J.A.B. (2015). Avalia\u00e7\u00e3o do Dano Neural Perif\u00e9rico Sensitivo e Motor em Pacientes Hansenianos, com HIV\/AIDS e co-Infectados Hansen\u00edase\/HIV Utilizando-se a Avalia\u00e7\u00e3o Neurol\u00f3gica Simplificada e T\u00e9cnicas Complementares. [Ph.D. Thesis, Federal University of Par\u00e1]. Available online: https:\/\/repositorio.ufpa.br\/jspui\/handle\/2011\/9105."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4103\/ijd.ijd_799_22","article-title":"The Correlation between Anthropometric Variables and Muscular Strength in Patients Coinfected with Leprosy and HIV","volume":"68","author":"Novais","year":"2023","journal-title":"Indian J. Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/S0166-2236(96)10058-8","article-title":"Nerve growth factor: From neurotrophin to neurokine","volume":"19","author":"Skaper","year":"1996","journal-title":"Trends Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1146\/annurev.ne.19.030196.001445","article-title":"Physiology of the neurotrophins","volume":"19","author":"Lewin","year":"1996","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"939","DOI":"10.3389\/fimmu.2018.00939","article-title":"Nerve Growth Factor and Pathogenesis of Leprosy: Review and Update","volume":"9","author":"Quaresma","year":"2018","journal-title":"Front Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0140-6736(94)91316-1","article-title":"Depletion of nerve growth factor in leprosy","volume":"344","author":"Anand","year":"1994","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1006\/cbir.1995.1089","article-title":"NGF: Not just for neurons","volume":"19","author":"Scully","year":"1995","journal-title":"Cell Biol. Int."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ioannou, M.S., and Fahnestock, M. (2017). ProNGF, but not NGF, switches from neurotrophic to apoptotic activity in response to reductions in TrkA receptor levels. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18030599"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"121","DOI":"10.47276\/lr.77.2.121","article-title":"Cyclosporine A treatment of leprosy patients with chronic neuritis is associated with pain control and reduction in antibodies against nerve growth factor","volume":"77","author":"Sena","year":"2006","journal-title":"Lepr. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"145","DOI":"10.11604\/pamj.2020.37.145.15213","article-title":"Evaluation of nerve growth factor serum level for early detection of leprosy disability","volume":"37","author":"Widasmara","year":"2020","journal-title":"Pan. Afr. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1159\/000517993","article-title":"Cyclosporin A as an Alternative Neuroimmune Strategy to Control Neurites and Recover Neuronal Tissues in Leprosy","volume":"29","author":"Jesus","year":"2022","journal-title":"Neuroimmunomodulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/FBP.0000000000000422","article-title":"Anti-NGF treatment can reduce chronic neuropathic pain by changing peripheral mediators and brain activity in rats","volume":"30","author":"Evangelista","year":"2019","journal-title":"Behav. Pharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.micpath.2014.10.005","article-title":"Relationship between growth factors and its implication in the pathogenesis of leprosy","volume":"77","author":"Esteves","year":"2014","journal-title":"Microb. Pathog."},{"key":"ref_36","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade (2025, February 12). Secretaria de Vigil\u00e2ncia em Sa\u00fade Departamento de Vigil\u00e2ncia, Preven\u00e7\u00e3o e Controle das Infec\u00e7\u00f5es Sexualmente Transmiss\u00edveis, do HIV\/Aids e das Hepatites Virais. Manual T\u00e9cnico para o Diagn\u00f3stico da Infec\u00e7\u00e3o pelo HIV em Adultos e Crian\u00e7as. Bras\u00edlia\u2014DF, Available online: https:\/\/www.gov.br\/aids\/pt-br\/central-de-conteudo\/publicacoes\/2018\/manual_tecnico_hiv_27_11_2018_web.pdf."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1093\/ajcp\/75.6.816","article-title":"The use of antiavidin antibody and avidin-biotin-peroxidase complex in immunoperoxidase technics","volume":"75","author":"Hsu","year":"1981","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.virol.2005.09.058","article-title":"Revisiting the liver in human yellow fever: Virus-induced apoptosis in hepatocytes associated with TGF-beta, TNF-alpha and NK cells activity","volume":"345","author":"Quaresma","year":"2006","journal-title":"Virology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S1473-3099(06)70493-5","article-title":"Interactions between HIV infection and leprosy: A paradox","volume":"6","author":"Ustianowski","year":"2006","journal-title":"Lancet Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"59","DOI":"10.47276\/lr.81.1.59","article-title":"Leprosy presenting as immune reconstitution inflammatory syndrome: Proposed definitions and classification","volume":"81","author":"Deps","year":"2010","journal-title":"Lepr. Rev."},{"key":"ref_41","first-page":"639","article-title":"Leprosy and AIDS: A review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae","volume":"59","author":"Miller","year":"1991","journal-title":"Int. J. Lepr. Other Mycobact. Dis."},{"key":"ref_42","first-page":"97","article-title":"Human immunodeficiency virus and leprosy","volume":"64","author":"Lucas","year":"1993","journal-title":"Lepr. Rev."},{"key":"ref_43","first-page":"155","article-title":"M. leprae-HIV co-infection: Pattern of immune response in vivo and in vitro","volume":"72","author":"Nery","year":"2000","journal-title":"Indian J. Lepr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.det.2010.08.016","article-title":"Human immunodeficiency virus and leprosy: An update","volume":"29","author":"Lockwood","year":"2011","journal-title":"Dermatol. Clin."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0304-3959(99)00273-0","article-title":"Do nerve growth factor-related mechanisms contribute to loss of cutaneous nociception in leprosy?","volume":"85","author":"Facer","year":"2000","journal-title":"Pain"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S0079-6123(03)46030-5","article-title":"Neurotrophic factors and their receptors in human sensory neuropathies","volume":"146","author":"Anand","year":"2004","journal-title":"Prog. Brain Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.micpath.2015.11.019","article-title":"Correlation between nerve growth factor and tissue expression of IL-17 in leprosy","volume":"90","author":"Botelho","year":"2016","journal-title":"Microb. Pathog."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1590\/S0004-282X2012000400012","article-title":"Leprosy patients: Neurotrophic factors and axonal markers in skin lesions","volume":"70","author":"Michellin","year":"2012","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/path.1711570104","article-title":"Changes in nerves and neuropeptides in skin from 100 leprosy patients investigated by immunocytochemistry","volume":"157","author":"Karanth","year":"1989","journal-title":"J. Pathol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.micinf.2012.02.010","article-title":"Transforming growth factor \u03b2 and apoptosis in leprosy skin lesions: Possible relationship with the control of the tissue immune response in the Mycobacterium leprae infection","volume":"14","author":"Fuzii","year":"2012","journal-title":"Microbes. Infect."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/S0140-6736(04)15952-7","article-title":"Leprosy","volume":"363","author":"Britton","year":"2004","journal-title":"Lancet"},{"key":"ref_52","first-page":"373","article-title":"Anti-nerve growth factor in pain management: Current evidence","volume":"9","author":"Chang","year":"2016","journal-title":"J. Pain Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1172\/JCI5863","article-title":"Initial increase in blood CD4(+) lymphocytes after HIV antiretroviral therapy reflects redistribution from lymphoid tissues","volume":"103","author":"Bucy","year":"1999","journal-title":"J. Clin. Investig."},{"key":"ref_54","first-page":"1","article-title":"Infectious Disease Society of America. Guidelines for preventing opportunistic infections among HIV-infected persons\u20142002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America","volume":"51","author":"Kaplan","year":"2002","journal-title":"MMWR Recomm. Rep."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4488","DOI":"10.4049\/jimmunol.153.10.4488","article-title":"Nerve growth factor production by lymphocytes","volume":"153","author":"Santambrogio","year":"1994","journal-title":"J. Immunol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s40249-017-0294-2","article-title":"Prevalence of autoantibodies against cellular antigens in patients with HIV and leprosy coinfection in the Amazon region","volume":"6","author":"Bichara","year":"2017","journal-title":"Infect. Dis. Poverty."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1046\/j.1365-4362.2001.01259.x","article-title":"Leprosy: Accessory immune system as effector of infectious, metabolic, and immunologic reactions","volume":"40","author":"Abulafia","year":"2001","journal-title":"Int. J. Dermatol."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/10\/2271\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T04:34:06Z","timestamp":1759206846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/10\/2271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,27]]},"references-count":57,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["microorganisms13102271"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13102271","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,27]]}}}