Initiation of antiretroviral therapy in HIV-infected adults with skin complaints in northern Tanzania

Int J Dermatol. 2015 Jan;54(1):68-73. doi: 10.1111/ijd.12563. Epub 2014 Sep 26.

Abstract

Abnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)-infected persons globally. A prospective cohort study of HIV-infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV-infected subjects presenting with skin complaints, who met criteria for ART initiation, were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed, and CD4(+) cell counts and plasma HIV RNA levels were measured. All subjects received a fixed-dose combination of stavudine, lamivudine, and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow-up. Median baseline CD4(+) cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log10 copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months, 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution, the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3, which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months, the median CD4(+) cell count had increased to 474 cells/μl, and plasma HIV RNA levels were <400 copies/ml in 85 (99%) subjects. Patients with HIV infection with skin complaints experienced marked clinical improvements following ART initiation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Female
  • HIV / genetics*
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • Humans
  • Lamivudine / therapeutic use
  • Male
  • Middle Aged
  • Nevirapine / therapeutic use
  • Prospective Studies
  • RNA, Viral / blood*
  • Severity of Illness Index
  • Skin Diseases / drug therapy*
  • Skin Diseases / virology*
  • Stavudine / therapeutic use
  • Tanzania
  • Young Adult

Substances

  • Anti-HIV Agents
  • RNA, Viral
  • Lamivudine
  • Nevirapine
  • Stavudine