Abstract
HIV has long been associated with a number of inflammatory, infectious, and neoplastic skin conditions. In the era of anti-retroviral therapy, we have discovered even more about the relationship between skin disease and chronic immunosuppression. In particular, clinicians still face the propensity of persons living with HIV to develop difficult-to-control viral infections, chronic skin inflammation, and pruritus and—particularly as patients age—various types of skin cancers. Here, we summarize recent updates in the field of HIV dermatology and make recommendations to providers caring for these patients.
Highlights
Since the early days of the human immunodeficiency virus (HIV) epidemic, dermatologists have confronted the myriad cutaneous manifestations that afflict persons living with HIV (PLWH)
Human papilloma virus (HPV)-related dysplastic changes may be found in up to 30% of individuals in this cohort; a recent study found that younger men who have sex with men (MSM) with histories of inadequate viral suppression were at high risk of developing HSIL2
In patients whose skin disease is refractory to these interventions and in settings where regular follow-up is available to monitor for symptoms and signs of infection, severe and refractory psoriasis be treated with all available therapies, including biologic agents
Summary
Since the early days of the human immunodeficiency virus (HIV) epidemic, dermatologists have confronted the myriad cutaneous manifestations that afflict persons living with HIV (PLWH). A recent (2018) clinical trial assessed HPV vaccine efficacy in HIV-infected MSM who were 27 years old or older[6]. Part of the problem is that sustained protection requires more than just high titers of specific neutralizing antibodies; the innate immune system on mucosal surfaces plays an important role in the early host response Another approach is to treat known latent HSV infection with vaccinations that boost immunity in order to limit recurrences, more akin to the strategy used with VZV. There have been several reports during the last decade of KS developing in HIV-negative MSM54–56 This likely reflects the higher rate of HHV-8 infection in this cohort; whereas the seroprevalence is less than 5% in the general US population, it is as high as 20 to 30% in HIV-uninfected MSM57. Practitioners caring for PLWH should be aware of this increased risk and inquire about growing skin lesions as part of routine health maintenance
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