Numerous plasmacytoid dendritic cell infiltration in HIV‐associated psoriasis relieved only with antiretroviral therapy

The onset of psoriasis is often seen in HIV infection, called HIV‐associated psoriasis. Although HIV‐associated psoriasis is usually refractory, there are some cases relieved only by antiretroviral therapy. In those cases, the pathogenesis may be formed differently from psoriasis vulgaris. We present the case of a 42‐year‐old Japanese man with HIV‐associated psoriasis. The patient developed a systemic scaly eruption, especially on the soles. Histopathological examination showed typical psoriatic findings and plasma cell infiltration into the dermis. The eruption dramatically remitted with antiretroviral therapy alone, without systemic treatment for psoriasis. In immunohistological findings, few CD4⁺ cells were seen in the patient's skin. In addition, immunofluorescent staining revealed more BDCA‐2 and CD123 double‐positive plasmacytoid dendritic cell infiltration into the dermis than that of psoriasis vulgaris. We suggest that the immune response to HIV including plasmacytoid dendritic cell infiltration may involve in the development and remission of HIV‐associated psoriasis.     

HIV medicine for dermatologists and venereologists

Broad administration of combined antiretroviral therapy (ART) has dramatically reduced the morbidity and mortality of the HIV‐infection and substantially improved the life expectancy of people living with HIV (PLWH). PLWH, who are effectively treated with an ART, are considered to be unable to transmit HIV. The standard of care is usually an antiretroviral single tablet regimen. Since 2015 the Robert Koch Institute has reported a slight decrease in the rate of recently diagnosed HIV‐infections in Germany, but the proportion of late presenters (initial diagnosis in advanced stages of infection) has remained consistently high at around 32 % since 2005. HIV‐infections have not been diagnosed in 10,800 PLWH so far. In comparison to the general population PLWH suffer more frequently from skin diseases. Depending on the stage of immunodeficiency, untreated PLWH develop HIV indicator diseases of the skin and the mucocutaneous membranes. Knowledge of these diseases facilitates the selection of individuals who should be offered HIV testing. Early diagnosis of HIV‐infections allows early introduction of the ART, prevents the spread of HIV and reduces the mortality rates and treatment costs associated with late diagnosis. HIV is a predominantly sexually transmitted infection. Through focused sexual anamnesis and the diagnosis of HIV indicator diseases and other sexually transmitted infections, dermatovenereologists in particular may be able to identify previously undiagnosed PLWH and persons with an increased risk of HIV infection, enabling initiation of ART in the former and pre‐exposure prophylaxis counseling in the latter.     

Immunology of AIDS related to psoriasis

The association of severe psoriasis with HIV infection, which dysregulates and destroys the human immune system, supports the hypothesis that psoriasis is an immunologically mediated disease. Psoriasis and Kaposi's sarcoma share angiogenesis as basic early findings and could both be caused by differential cytokine expression or responsiveness. AIDS and research models including transgenic mice offer new models in which to study the role of the immune system and specific gene products in the pathogenesis of psoriasis and other skin diseases.     

河南省某艾滋病高流行地区艾滋病病例漏报调查

目的 了解河南省某艾滋病高流行地区艾滋病病例漏报原因。 方法 在横断面调查基础上,采用回顾性调查研究,了解1998-2007年河南省某艾滋病高流行地区常住人口艾滋病感染及发病情况,与艾滋病疫情网已报告数据比较,分析漏报原因。 结果 调查发现116例艾滋病病例漏报。单因素分析显示感染途径（χ2=4.57,P=0.03）、艾滋病发病（χ2=13.84,P<0.01）、抗病毒治疗（χ2=91.91,P<0.01）、是否死亡（χ2=113.03,P<0.01）、死亡时间（χ2=46.77,P<0.01）、死前最高治疗单位（χ2=17.55,P<0.01）对艾滋病病例漏报有影响;多因素Logistic回归分析显示抗病毒治疗（χ2=15.46,P<0.01）、死前最高治疗单位（χ2=4.21,P=0.04）、死亡时间（χ2=7.29,P<0.01）对艾滋病病例漏报影响显著。 结论 艾滋病发病未治疗或仅在低级别医疗机构治疗以及死亡时间早等原因是影响艾滋病病例漏报的主要因素。     

HIV‐associated psoriasis: Epidemiology,pathogenesis, and management

People living with HIV (PLWH) are affected by a higher incidence skin disorders, which are often associated with high morbidity and mortality. In particular, psoriasis affects PLWH severely and for a longer time than the general population. Human immunodeficiency virus (HIV) infection is characterized by a progressive decrease in CD4⁺ T‐cell count, and it could seem paradoxical that psoriasis exacerbations are more frequent in this subset of patients than the general population, even though it is commonly observed at any stage of infection. For a long time, there have been limited therapeutic choices for PLWH affected by psoriasis. The introduction of the combined antiretroviral therapy dramatically changed the natural course of both HIV and psoriasis in PLWH, leading to an improvement of quality and duration of life. However, the clinical severity of psoriasis in PLWH often requires the use of immunosuppressant drugs. Knowledge about their safety and efficacy are limited to case‐reports, small case‐series and studies, therefore their use has not yet entered the routine. Further studies are needed to determine if immunosuppressive drugs can be safely and effectively used in PLWH affected by psoriasis and other autoimmune disorders.     

云南省保山市1998—2019年缅籍HIV感染者/AIDS病人随访管理情况分析

目的分析云南省保山市境内(1998—2019)年新报告的缅籍HIV感染者/AIDS病人(HIV/AIDS)随访管理现状,为政府制订相关防控措施提供科学依据。方法以云南省保山市1998年至2019年底累计发现的1 075例缅籍HIV/AIDS为研究对象,分析该人群在随访管理、CD_4^+T淋巴细胞计数检测和抗病毒治疗(ART)等艾滋病相关管理现况。结果 (1998—2019)年保山市累计报告缅籍HIV/AIDS 1 075例,呈快速上升趋势。当前随访比例为22.3%,CD_4^+检测比例为24.8%,ART比例为8.9%,均低于保山本地HIV/AIDS,差异有统计学意义(P<0.001)。曾经做过1次或以上检查者占44.7%;曾接受过ART的占16.6%,ART脱失率达42.1%,配偶/固定性伴检测率为57.5%,配偶检出阳性率为38.3%。多因素分析发现,性别、治疗情况、样本来源对随访的影响有统计学意义(P<0.05)。结论缅籍HIV/AIDS随访比例、CD_4^+T淋巴细胞计数检测比例以及ART比例均较低,配偶检出阳性率较高,随访管理质量不高,需要进一步加强对该人群的随访并探索有效的管理模式。     

Avoiding unnecessary fragrance-induced pigmented contact dermatitis: the 'pulse point' myth

Molluscum contagiosum is a common viral skin infection in children with atopic diathesis and not rare in HIV patients. We report a 45-year-old psoriasis patient who developed eruptive mollusca contagiosa during an antipsoriatic treatment with efalizumab.     

有银屑病表现的艾滋病1例

报告以银屑病为表现的艾滋病1例。患者，女，27岁。全身鳞屑性红色斑丘疹半年余。皮肤组织病理符合银屑病改变；人免疫缺陷病毒（HIV）初筛实验（ELISA）及确证实验（Western blot)阳性；CD4细胞计数下降；CD4／CD8＜1。患者于诊断为艾滋病半年后死亡。     

Changes in the transmission dynamics of the HIV epidemic after the wide-scale use of antiretroviral therapy could explain increases in sexually transmitted infections: results from mathematical models

BACKGROUND: Recent increases in bacterial sexually transmitted infections (STI) and risk behavior have coincided with the introduction of antiretroviral therapy (ART) in homosexual communities of industrialized countries. The reasons for these increases are not fully understood. GOAL: The goal of this study was to understand the various effects of ART on risk behaviors and STI. OBJECTIVE: The objective of this study was to assess the independent impact of the change in the transmission dynamics of HIV/AIDS as a result of the wide-scale use of ART on a bacterial STI. STUDY DESIGN: We developed a mathematical model of bacterial STI and treated/untreated HIV/AIDS infection for an open homosexual population. At the individual level, we assume that susceptible and healthy HIV-positive individuals do not increase their risk behavior as a result of ART over time. However, individuals with AIDS, who are successfully treated with ART, can resume sexual activity. The impact of the wide-scale use of ART on risky behavior, STI, and HIV/AIDS was evaluated over a wide range of assumptions on treatment use, ART efficacy, and population characteristics. RESULTS: Over 10 years, 0% to 55% new bacterial STI could be attributed to the wide-scale use of ART as a result of more modest increases (0-25%) in risky sex occurring at the population level rather than at the individual level. These increases have a negative impact on HIV if coverage is too low. Increasing treatment coverage helps to prevent more HIV infections despite larger increases in risky sex and STI that is predicted to ensue. CONCLUSION: Taking the differential impact of wide-scale use of ART into account helps to interpret recent behavioral and STI trends. Our results have implications for prevention strategies and for the formulation of public health policies. A better understanding of the differential impact of ART on sexual network over time is required.     

The spectrum of mucocutaneous manifestations during the evolutionary phases of HIV disease: an emerging Indian scenario.

Third world countries, including India, lack sophisticated investigations to assess the progression of HIV disease. Hence, this study was undertaken to determine the clinical mucocutaneous markers of HIV disease and to establish its relationship with the stage of the disease. This was an observational institutional study of 75 patients with mucocutaneous disorders and HIV infection recruited over a period extending from September of 1996 to June of 1998. The patients with mucocutaneous lesions were staged according to the Centers for Disease Control classification system for HIV infection (1986). The most frequent mode of acquisition of HIV infection was heterosexual contact (96%). The patients were broadly categorized into two groups. The AIDS group was comprised of patients who were in group IV and the early HIV infection group included patients in group II and III; none were detected in group I. Forty-eight cases belonged to the AIDS group, and 27 belonged to the early HIV infection group. A total of 207 dermatoses were diagnosed and grouped as fungal, viral, bacterial, or miscellaneous. The common mucocutaneous disorders in order of frequency observed in this study were: candidiasis, dermatophytosis, herpes simplex, oral aphthae, xerosis/ichthyosis, scabies, HPV infection, molluscum contagiosum, and psoriasis. Xerosis/acquired ichthyosis and giant molluscum contagiosum were characteristically seen in group IV of HIV disease, whereas oral candidiasis, oral aphthae, papular dermatitis of HIV, and psoriasis were early warning signs. The mean number of dermatoses per patient in group IV was 3.15; in group III, it was 2.41; and in group II, it was 1.5. There was a statistically significant difference between the early HIV infection group and AIDS group with regard to number of dermatoses. Apart from syphilis and human papilloma virus infection, the treatment outcomes were satisfactory.     

Psoriasis in the patient with human immunodeficiency virus, Part 2: Review of treatment

Psoriasis is a chronic, immune-mediated skin disease affecting approximately 1% to 3% of the human immunodeficiency virus (HIV)-infected population. Psoriasis appears in patients with HIV either as the first clinical manifestation of the disease or, less commonly, during the advanced stages of HIV when it has progressed to AIDS. This 2-part series reviews the pathogenesis of HIV-associated psoriasis as well as the various therapeutic regimens that have effectively treated psoriasis in patients with HIV. These therapies address the profound immune dysregulation that defines psoriasis. The second part of the series focuses on the treatment of HIV-associated psoriasis.     

Initiation of antiretroviral therapy in HIV‐infected adults with skin complaints in northern Tanzania

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 CD4⁺ 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 CD4⁺ cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log₁₀ 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 CD4⁺ 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.     

Human immunodeficiency virus-associated vitiligo: expression of autoimmunity with immunodeficiency?

Persistent viral infections have been postulated to be trigger factors for the development of autoimmune disease. We report the development of vitiligo in four patients with human immunodeficiency virus (HIV)-related conditions and in one patient with hepatitis who later developed both psoriasis and acquired immunodeficiency syndrome (AIDS). Other common features were hepatitis and multiple other viral infections. Ribavirin was associated with repigmentation in one patient. Vitiligo may be an example of an autoimmune disease triggered by viral infection in a genetically predisposed host.     

HIV感染者53例皮肤黏膜疾病和性传播疾病的临床分布

目的探讨贺州市53例HIV感染者皮肤黏膜疾病及性传播疾病的病种分布、临床表现以及经性途径感染艾滋病变化的特点。方法回顾分析53例HIV感染者在门诊就诊期间皮肤黏膜及性传播疾病的种类、特征及实验室检查资料。结果 HIV感染者传播途径以性传播者占84.91%;皮肤黏膜损害复杂,以真菌、病毒感染等为主;疾病种类依次为性病、带状疱疹、湿疹、银屑病、泛发体癣等8种;有2种以上皮肤黏膜疾病者8例(15.09%);性传播疾病以早期梅毒为主13例(24.53%)。结论 HIV感染者皮肤黏膜损害以真菌、感染最多,性传播途径是HIV感染的主要途径之一,泛发的皮肤黏膜病变和合并性病感染可作为诊断HIV感染的依据之一。     

Skin disorders affecting human immunodeficiency virus-infected children living in an orphanage in Ethiopia

Background. Skin disorders are common in children in Ethiopia, and it is estimated that 92 000 Ethiopian children are infected with human immunodeficiency virus (HIV). HIV infection increases the prevalence of cutaneous disease, but the effect of antiretroviral therapy (ART) on the pattern of skin disease affecting children in sub‐Saharan Africa (SSA) is unclear. Aim. To assess the prevalence and nature of skin disorders in HIV‐infected children living in a dedicated orphanage in Addis Ababa, Ethiopia. Methods. Two dermatologists performed a clinical examination, including the skin, hair, nails and oral cavity of all the residents of an orphanage in Addis Ababa. The examiners knew that all the children were infected with HIV, but did not know their treatment or immune status. Diagnoses were made clinically and recorded anonymously, and treatment recommendations were made. Details of the children’s treatment and CD4 lymphocyte counts were obtained after the examination had been completed. Results. In total, 84 children [53 male (63%); 31 female (37%); median age 10 years] were examined. Of the 84 children, 57 (68%) were on ART, with 51 (61%) of these on cotrimoxazole prophylaxis. The median CD4 percentage was 27.1%. There were 66 children (79%) with at least one skin disorder; 21 of these had two disorders and 6 had three disorders. The commonest diagnosis was tinea capitis, affecting 39% of children. The other common diagnoses were: molluscum contagiosum (MC) (21%), verruca vulgaris (13%), plane warts (8%) and seborrhoeic dermatitis (7%). There was no significant difference in the prevalence of skin disease between children receiving ART and those who were not. Children with MC had significantly lower recent CD4 counts than children who did not have skin disease. Conclusions. Skin disorders in this population were very common, and the disorders identified were those that commonly affect children without HIV in Ethiopia. However, MC and plane warts appeared to have a higher frequency than would be expected in uninfected children.     

Skin manifestations in patients with HIV infection

Cutaneous manifestations are common in patients with HIV infection and mainly due to the immunodeficiency. In the initial stage of HIV infection, we frequently observe a rash of macular lesions. During the asymptomatic phase, the patients may typically show the following skin diseases: seborrhoic dermatitis, acneiform folliculitis, persistent herpes simplex, and infections with the human papilloma virus. In ARC and AIDS patients, 3 groups of skin disorders are found: cutaneous infections, skin tumors, and other mixed skin diseases. Herpes simplex and herpes zoster may develop into ulcerating and necrotising forms especially in patients with advanced immunodeficiency. The most frequent skin tumors in AIDS patients are the disseminated Kaposi's sarcoma and non-Hodgkin's lymphoma. More than 50% of the AIDS patients treated with trimethoprim/sulfamethoxazole developed a severe drug eruption. African and Caribbean patients with AIDS frequently suffer from pruritic skin lesions, the pathogenesis of which is not known. Aside from these cutaneous manifestations, a variety of other skin disorders have been reported in patients with HIV infection, ARC, or AIDS; future research will furnish definite proof whether they are correlated with HIV infection.     

Cytokine expression patterns distinguish HIV associated skin diseases

AIDS is known to cause a shift of cytokines in the periphery. However, predominant cytokines in skin of patients with HIV-associated skin diseases have not been clearly defined. We hypothesized that there are distinct cytokine profiles that distinguish among the different clinical manifestations of AIDS-related skin diseases. To test this hypothesis, lesional and non-lesional skin was biopsied from 53 HIV+ patients with Kaposi's sarcoma (KS), psoriasis, and pruritus due to eosinophilic folliculitis, and from HIV negative controls with psoriasis or KS prior to therapy. Immunohistochemistry was performed with antibodies to tumor necrosis factor (TNF)-alpha, interleukin (IL)-10, interferon (IFN)-gamma, and interferon-inducible protein (IP)-10. HIV positive individuals included 10 with psoriasis, 14 with pruritus, and 15 with Kaposi's sarcoma. HIV negative controls included 12 with psoriasis and two with KS. Semi-quantitative analysis of cytokine staining was confirmed by optical density using a digital imaging system on four representative skin sections from each disease. Optical density analyses were conducted using ANOVA and t-tests. We found that epidermis overlying HIV+ Kaposi's sarcoma was hyperproliferative and was highest in IP-10, IFN-gamma, and IL-10 (P=0.0001). HIV+ pruritus was significantly highest in TNF-alpha (P=0.0001) staining. HIV+ psoriasis represented an intermediate state for all four cytokines. Normal skin adjacent to lesions showed the same relative patterns, with lower intensities. Skin diseases seen frequently in the setting of HIV and immunodeficiency have relatively distinct levels and patterns of cytokine expression that may reflect immune dysfunction, reactivity to HIV and to opportunistic infections.     

Psoriasis in the patient with human immunodeficiency virus, part 1: review of pathogenesis

Psoriasis is a chronic, immune-mediated skin disease affecting approximately 1% to 3% of the human immunodeficiency virus (HIV)-infected population. The presentation of psoriasis in patients with HIV varies. It either presents as the first clinical manifestation of HIV or, less commonly, appears in the advanced stages of HIV when it has progressed to AIDS. This 2-part series reviews the pathogenesis of HIV-associated psoriasis as well as the various therapeutic regimens that have effectively treated psoriasis in patients with HIV These therapies address the profound immune dysregulation that defines psoriasis. The first part of the series focuses on the pathogenesis of HIV-associated psoriasis.     

Spontaneous clinical improvement in HIV-associated follicular syndrome

Since 1991 infrequent reports have described a distinctive triad of nodulocystic acne, striking follicular spines and an eruption resembling pityriasis rubra pilaris (PRP) in HIV-positive patients. It has been suggested that this may represent a subtype of PRP, or alternatively that it should be viewed as a unique HIV-associated follicular occlusion triad. Clinical manifestations may be severe, and in several cases have been ultimately fatal, with death occurring due to complications of cutaneous sepsis. We describe a case demonstrating severe conglobate acne, follicular keratotic spines and histologically confirmed PRP in association with HIV infection. Clinical features and treatment modalities of previously reported cases are reviewed. Despite refusing all topical and systemic treatment our patient showed spontaneous remission of skin signs after 2 years.     

Dermatoses among Brazilian HIV-positive patients: correlation with the evolutionary phases of AIDS

Background The presence of dermatoses is very common in Acquired Human Immunodeficiency Syndrome (AIDS). The present study was undertaken to correlate the various dermatoses with the evolutionary phases of AIDS. Methods We examined 223 HIV-infected patients older than 13 seen at the University of São Paulo, Faculty of Medicine of Ribeirão Preto, from 1989 to 1993. Patients were divided according to the CDC classification and assigned to groups I, II and III (initial stages of AIDS) and to group IV (fully symptomatic stage of AIDS). Results The mean frequency of dermatoses detected in patients with AIDS was higher compared to the early phases of HIV infection. The most frequently detected dermatoses were, in decreasing order of occurrence, dermatoses of fungal etiology, and desquamating disorders, such as psoriasis, seborrheic dermatitis, xerosis, and viral dermatoses. Conclusions A careful examination of skin and mucosae may be highly useful for the diagnosis of HIV infection. The number of dermatoses tended to increase during the more advanced stages of infection.