Moxifloxacin for Buruli ulcer/HIV coinfected patients: kill two birds with one stone?

Buruli ulcer is a necrotizing infection of skin and soft tissue caused by Mycobacterium ulcerans that results in significant morbidity and often long-term disability. It is endemic in West and Central Africa affecting regions similarly burdened by a high prevalence of HIV. According to the Médecins Sans Frontières programme in Akonolinga, Cameroon, the prevalence of HIV is approximately three to six times higher in Buruli ulcer-treated patients compared to the regional estimated HIV prevalence [1]. Similarly in Benin, patients with Buruli ulcer were eight times more likely to have HIV infection than those without Buruli ulcer [2]. HIV also affects the clinical presentation of Buruli ulcer disease with an increased incidence of multiple, larger, and ulcerated lesions [1,3]. Patients often present with severe immunosuppression, with 26% of patients in Akonolinga presenting with CD4þ cell counts less than 200 cells/ml, and in urgent need of antiretroviral therapy [1].