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Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era
Author(s) -
Chua S.L.,
Amerson E.H.,
Leslie K.S.,
McCalmont T.H.,
Leboit P.E.,
Martin J.N.,
Bangsberg D.,
Maurer T.A.
Publication year - 2014
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12721
Subject(s) - medicine , rash , odds ratio , skin biopsy , cohort , etiology , viral load , dermatology , antiretroviral therapy , case control study , biopsy , cohort study , human immunodeficiency virus (hiv) , immunology
Summary Background Pruritic papular eruption ( PPE ) of HIV is common in HIV ‐infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy ( ART ). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. Objectives To determine factors associated with PPE in HIV ‐infected persons receiving ART . Methods A case–control study nested within a 500‐person cohort from a teaching hospital in Mbarara, Uganda. Forty‐five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. Results Twenty‐five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL −1 (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation ( P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8 + T‐cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). Conclusions Pruritic papular eruption in HIV ‐infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD 4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions.