Mavura Daudi R, Masenga E John, Minja Eli, Grossmann Henning, Crump John A, Bartlett John A
Regional Dermatology Training Center, Moshi, Tanzania; Kilimanjaro Christian Medical Center, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Int J Dermatol. 2015 Jan;54(1):68-73. doi: 10.1111/ijd.12563. Epub 2014 Sep 26.
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.
全球超过90%的人类免疫缺陷病毒（HIV）感染者存在皮肤异常表现。在坦桑尼亚北部开展了一项针对开始接受抗逆转录病毒治疗（ART）的有皮肤问题的HIV感染患者的前瞻性队列研究。在坦桑尼亚一个地区皮肤病培训中心招募了符合ART启动标准、有皮肤问题的连续HIV感染受试者。由一名皮肤科医生对所有受试者进行评估；进行基线皮肤活检，并检测CD4(+)细胞计数和血浆HIV RNA水平。所有受试者均接受司他夫定、拉米夫定和奈韦拉平的固定剂量组合治疗。共纳入100名受试者；86名受试者完成了6个月的随访。基线CD4(+)细胞计数和血浆HIV RNA水平的中位数分别为120个细胞/μl和5.2 log10拷贝/ml。最常见的皮肤病是丘疹性瘙痒性皮疹（47%）。烧伤量表的基线中位数评分为38%。6个月后，10名受试者的皮肤异常完全消退。在那些没有完全消退的受试者中，烧伤量表的中位数评分改善至7%。5名患者在第3个月出现新的皮疹，其中2例归因于药物反应。在6个月后仍接受ART治疗的86名受试者中，CD4(+)细胞计数的中位数增加到474个细胞/μl，85名（99%）受试者的血浆HIV RNA水平<400拷贝/ml。有皮肤问题的HIV感染患者在开始ART治疗后临床症状有显著改善。
