78 - Cutaneous Manifestations of HIV Infection

Abstract

This chapter reviews the human immunodeficiency virus (HIV) pandemic and the broad spectrum of infectious, inflammatory, and neoplastic skin conditions that may occur in the setting of HIV-induced immune dysfunction. Because cutaneous manifestations often correlate with immune status, knowledge of a patient’s viral load and CD4+ T cell count can help generate a more focused differential diagnosis. HIV infection should be considered when patients present with severe, unusual, and treatment-resistant skin conditions; examples include giant molluscum contagiosum, extensive seborrheic dermatitis, and refractory herpes simplex virus infection. Following initiation of antiretroviral therapy (ART), skin disorders such as herpes zoster and non-tuberculous mycobacterial infection may become clinically apparent or worsen when the immune status improves, a phenomenon known as the immune reconstitution inflammatory syndrome (IRIS). Although ART has led to a reduction in the frequency of severe opportunistic infections and skin conditions associated with advanced HIV disease (e.g. Kaposi sarcoma), other dermatologic problems have become more common, including lipodystrophy and neoplasia related to human papillomavirus infection. In addition, the medications used in ART can cause drug eruptions.