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Initiation of antiretroviral therapy in HIV ‐infected adults with skin complaints in northern Tanzania
Author(s) -
Mavura Daudi R.,
Masenga E. John,
Minja Eli,
Grossmann Henning,
Crump John A.,
Bartlett John A.
Publication year - 2015
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.12563
Subject(s) - medicine , nevirapine , stavudine , lamivudine , prospective cohort study , viral load , cohort , antiretroviral therapy , human immunodeficiency virus (hiv) , surgery , dermatology , immunology , virus , hepatitis b virus
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 CD 4 + 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 CD 4 + cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log 10 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 CD 4 + 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.