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Dermatologic Adverse Effects of Antiretroviral Therapy

Recognition and Management

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Abstract

Despite the decrease in opportunistic infections associated with HIV in the highly active antiretroviral treatment (HAART) era, a significant number of patients still present with skin pathology, some of which can be attributed directly or indirectly to antiretroviral therapy. The non-nucleoside reverse transcriptase inhibitors exhibit a class effect with regard to skin adverse manifestations, and the spectrum of disease can vary from a mild morbilliform rash to Stevens-Johnson syndrome. Certain protease inhibitors are associated with rash, and indinavir causes retinoid-like manifestations such as paronychia, alopecia, ingrown toe-nails, and curling of straight hair. Abacavir, a nucleoside reverse transcriptase inhibitor, is notorious for causing a hypersensitivity reaction in select patients. The fusion inhibitor enfuvirtide causes injection-site reactions in the overwhelming majority of patients, although a new method of delivery has decreased the rate and severity of these reactions. A syndrome of lipoatrophy with or without lipohypertrophy, often termed lipodystrophy, has been described in patients receiving HAART. Potential management of lipoatrophy includes switching antiretrovirals and surgical treatment with facial fillers. Lastly, skin manifestations of the immune reconstitution inflammatory syndrome, including herpes zoster and warts, must be recognized and treated accordingly. In the evaluation of the individual HIV-infected patient receiving antiretroviral therapy who presents with a skin disorder, clinicians should consider the CD4 cell count as a marker of the degree of immunodeficiency, the specific antiretrovirals used, and the timing of the initiation of antiretroviral therapy in order to formulate a rational differential diagnosis. Management should be individualized based on the specific drug that is implicated and the severity of the reaction.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

This work was supported by National Institutes of Health grant R01-DK065515. Dr Glesby has received research support and served as an ad hoc consultant to Serono Laboratories and has received an honorarium for lecturing from Abbott Laboratories. Dr Luther has no conflicts of interest that are directly relevant to the content of this review. The authors thank Dr Toby Maurer for providing photographs and critically reviewing the manuscript.

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  1. Upstate Medical School, State University of New York, Syracuse, New York, USA

    Jay Luther

  2. Division of International Medicine and Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, USA

    Marshall J. Glesby

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Luther, J., Glesby, M.J. Dermatologic Adverse Effects of Antiretroviral Therapy. Am J Clin Dermatol 8, 221–233 (2007). https://doi.org/10.2165/00128071-200708040-00004

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