Cutaneous effects of highly active antiretroviral therapy in HIV-infected patients

Abstract

Effective highly active antiretroviral therapy (HAART) has increased survival in patients infected with the human immunodeficiency virus (HIV). However, HAART is not without toxicities. Cutaneous adverse reactions from antiretroviral agents have become increasingly important to recognize as the population of patients surviving with HIV infection grows. Dermatologists play an important role in managing these cutaneous effects of HAART therapy in HIV patients. This article reviews cutaneous adverse effects from nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and fusion inhibitors, as well as separately addresses lipodystrophy, and immune reconstitution.

History of viral suppression on combination antiretroviral therapy as a predictor of virological failure after a treatment change*

“…The greatest risk of viral rebound has been shown to be in the first few months after initial suppression [14], and therefore it follows that increasing time since last virological rebound decreased the risk of virological failure after baseline. This could be attributable to problems associated with starting a new regimen, such as tolerability [35].…”

Prevalence and Impact of Body Physical Changes in HIV Patients Treated with Highly Active Antiretroviral Therapy: Results from a Study on Patient and Physician Perceptions

“…Skin and nail hyperpigmentation has been observed with emtricitabine and zidovudine use, and jaundice and conjunctival pigmentation secondary to hyperbilirubinemia are side effects observed with atazanavir and indinavir use. 14,34,35 Most of these antiretroviral-induced physical changes usually occur soon after the start of therapy and, with the exception of lipodystrophy, are usually reversible or treatable. Fat changes are not easily treatable, and might even cause chronic disfigurement and pain.…”

Cutaneous toxicities of antiretroviral therapy for HIV

“…3,8,11,12 Other adverse effects of nevirapine have included case reports of oral ulcers (Fig 2) and cases of acute generalized exanthematous pustulosis, both of which resolved with discontinuation of nevirapine, and a patient with the development of a white plaque on the buccal mucosa associated with xerostomia and a burning sensation that resolved following cessation of nevirapine. [13][14][15] SJS has also been reported in association with nevirapine, and nevirapine is one of the more common causes of SJS in the developing world, where nevirapine is frequently used 2,4,16,17 (Fig 3).…”