HIV medicine for dermatologists and venereologists

Abstract

Broad administration of combined antiretroviral therapy (ART) has dramatically reduced the morbidity and mortality of the HIV-infection and substantially improved the life expectancy of people living with HIV (PLWH). PLWH, who are effectively treated with an ART, are considered to be unable to transmit HIV. The standard of care is usually an antiretroviral single tablet regimen. Since 2015 the Robert Koch Institute has reported a slight decrease in the rate of recently diagnosed HIV-infections in Germany, but the proportion of late presenters (initial diagnosis in advanced stages of infection) has remained consistently high at around 32 % since 2005. HIV-infections have not been diagnosed in 10,800 PLWH so far. In comparison to the general population PLWH suffer more frequently from skin diseases. Depending on the stage of immunodeficiency, untreated PLWH develop HIV indicator diseases of the skin and the mucocutaneous membranes. Knowledge of these diseases facilitates the selection of individuals who should be offered HIV testing. Early diagnosis of HIV-infections allows early introduction of the ART, prevents the spread of HIV and reduces the mortality rates and treatment costs associated with late diagnosis. HIV is a predominantly sexually transmitted infection. Through focused sexual anamnesis and the diagnosis of HIV indicator diseases and other sexually transmitted infections, dermatovenereologists in particular may be able to identify previously undiagnosed PLWH and persons with an increased risk of HIV infection, enabling initiation of ART in the former and pre-exposure prophylaxis counseling in the latter.

Online HIV/STI Risk Test (ORT): A prospective cross‐sectional study among sexually active individuals in Germany

“…Such an observation is consistent with earlier reports that MSM are disproportionally affected by STI such as Chlamydia trachomatis, Neisseria gonorrhoeae, or syphilis [27,28]. Therefore, increasing access to cost-free and anonymous STI testing comparable to that available for HIV needs to be part of the public health strategy [29]. As with STIs, the incidence of HIV among MSM in our cohort was also slightly higher than reported among males in general and females and is consistent with the data on surveillance of recent HIV infections among newly diagnosed HIV cases in Germany between 2008 and 2014 [30].…”

Karakteristik Penyakit Kulit dan Kelamin pada Penderita Infeksi Human Immunodeficiency Virus di Rumah Sakit Umum Daerah Buleleng

“…Penyakit kulit tersebut dapat terkait dengan infeksi oportunistik, neoplasma, erupsi obat (adverse drug reactions), dermatosis, xerosis (kulit kering), dan kelainan pada orofaring. Manifestasi penyakit kulit dan kelamin pada pasien HIV dikaitkan dengan signifikan dengan morbiditas pasien (Esser & Sammet, 2021).Manifestasi penyakit kulit dan kelamin secara kuantitatif maupun kualitatif didapatkan bervariasi mulai dari insiden, manifestasi klinis serta tingkat keparahan diantara berbagai etnis, ras dan daerah. Latar belakang lingkungan, budaya ataupun genetik juga menjelaskan variasi ini (Karadag et al, 2020).…”

Cutaneous Manifestations of Sexually Transmitted Infections

“…Mucocutaneous manifestations are typically more common as CD4 cell count drops, HIV RNA level increases, and immune function decreases. Studies found that pruritic papular rashes, psoriasis, and drug-induced reactions were more likely among PLWHs with CD4 < 200 (Esser & Sammet, 2021;Mirnezami et al, 2020). Some other conditions, such as varicella-zoster, may occur at any stages of HIV regardless of CD4 cell count; however, the manifestation may be more severe and extensive than compared with someone living without HIV (Chelidze et al, 2019).…”