Skin Complications of HIV Infection
Infection with HIV leads to a decrease in cell-mediated immunity resulting in a variety of opportunistic infections of viral, bacterial and fungal etiology. Cutaneous manifestations of infectious and noninfectious causes are frequently reported in HIV patients. Some infectious diseases, such as herpes simplex, herpes zoster, human papillomavirus, bacterial folliculitis and dermatophytosis, are commonly observed in the general population but may have a severe or recalcitrant course in HIV/AIDS patients. Other diseases, such as bacillary angiomatosis and disseminated fungal infections, are rare and limited to immunocompromised individuals. With the advent of highly active antiretroviral therapy in the 1990s, drug reactions have become more frequent. HIV/AIDS patients can have reactions to antiretroviral medications, including a morbilliform rash, urticaria, Stevens–Johnson syndrome and drug hypersensitivity syndrome.
Since 1981, when the first cases of AIDS were identified, HIV has become an epidemic in our country. The US CDC estimates that in 2006 more than 1 million individuals were infected with HIV in the USA. Significant advances have been made in the prevention and treatment of HIV and AIDS, which has allowed for the annual reported cases of AIDS in the USA to remain stable at 40,000 and improved the survival period for those with AIDS.
The WHO has defined four clinical stages of HIV infection (Box 1). Stage 1 is characterized by asymptomatic HIV seropositivity with a CD4 T-lymphocyte count of 500 cells/µl or more. Stage 2 is characterized by mild symptoms and a CD4 count of 350–499 cells/µl. Patients with Stage 3 HIV infection have advanced disease with a CD4 count of 200–349 cells/µl. Stage 4 is considered severe infection, AIDS, with a CD4 count of 200 cells/µl or less. HIV is associated with a multitude of opportunistic infections. These patients can have a variety of cutaneous manifestations of their disease, these manifestations vary with the stage of infection and may be infectious or noninfectious. Often they are conditions that are seen in the general population, such as herpes simplex (HSV) infection or seborrheic dermatitis, but may have a more severe, recalcitrant course in HIV patients. Other conditions, such as Kaposi's sarcoma, bacillary angiomatosis and eosinophilic folliculitis, are limited to immunocompromised individuals. The aim of the following discussion is to focus on some of the most common skin manifestations, those that may pose a diagnostic challenge and those related to the development of highly active antiretroviral therapy (HAART).
Abstract and Introduction
Abstract
Infection with HIV leads to a decrease in cell-mediated immunity resulting in a variety of opportunistic infections of viral, bacterial and fungal etiology. Cutaneous manifestations of infectious and noninfectious causes are frequently reported in HIV patients. Some infectious diseases, such as herpes simplex, herpes zoster, human papillomavirus, bacterial folliculitis and dermatophytosis, are commonly observed in the general population but may have a severe or recalcitrant course in HIV/AIDS patients. Other diseases, such as bacillary angiomatosis and disseminated fungal infections, are rare and limited to immunocompromised individuals. With the advent of highly active antiretroviral therapy in the 1990s, drug reactions have become more frequent. HIV/AIDS patients can have reactions to antiretroviral medications, including a morbilliform rash, urticaria, Stevens–Johnson syndrome and drug hypersensitivity syndrome.
Introduction
Since 1981, when the first cases of AIDS were identified, HIV has become an epidemic in our country. The US CDC estimates that in 2006 more than 1 million individuals were infected with HIV in the USA. Significant advances have been made in the prevention and treatment of HIV and AIDS, which has allowed for the annual reported cases of AIDS in the USA to remain stable at 40,000 and improved the survival period for those with AIDS.
The WHO has defined four clinical stages of HIV infection (Box 1). Stage 1 is characterized by asymptomatic HIV seropositivity with a CD4 T-lymphocyte count of 500 cells/µl or more. Stage 2 is characterized by mild symptoms and a CD4 count of 350–499 cells/µl. Patients with Stage 3 HIV infection have advanced disease with a CD4 count of 200–349 cells/µl. Stage 4 is considered severe infection, AIDS, with a CD4 count of 200 cells/µl or less. HIV is associated with a multitude of opportunistic infections. These patients can have a variety of cutaneous manifestations of their disease, these manifestations vary with the stage of infection and may be infectious or noninfectious. Often they are conditions that are seen in the general population, such as herpes simplex (HSV) infection or seborrheic dermatitis, but may have a more severe, recalcitrant course in HIV patients. Other conditions, such as Kaposi's sarcoma, bacillary angiomatosis and eosinophilic folliculitis, are limited to immunocompromised individuals. The aim of the following discussion is to focus on some of the most common skin manifestations, those that may pose a diagnostic challenge and those related to the development of highly active antiretroviral therapy (HAART).
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