Pruritus in HIV-1 disease: therapy with drugs which may modulate the pattern of immune dysregulation.
BACKGROUND
Pruritus in HIV-1+ patients is common and increases with disease progression. The causes of pruritus are numerous including xerosis, drug and photoeruptions, follicular and papular eruptions as well as infestations and infections by a wide range of organisms. One other possible factor contributing to pruritus is the pattern of immune dysregulation. With advancing HIV-1 disease there is Th1 to Th2 cytokine switching.


METHODS
After some positive results with prostaglandin inhibitors, we undertook a study in which we randomly placed patients on four different forms of therapy for their pruritus. The therapies included hydroxyzine with or without doxepin at night, pentoxifylline, indomethacin and topical moisturization with medium-strength topical steroids. All patients were evaluated for both subjective relief as well as side effects.


RESULTS
Patients placed on indomethacin obtained relief more consistently and more completely. Patients on pentoxifylline had the fewest side effects of all oral therapies. Patients on antihistamines with or without doxepin had the highest incidence of side effects, although more of these patients reported a greater degree of relief than patients on pentoxifylline. All patients on oral therapy overall had greater relief than patients using topical steroids.


CONCLUSIONS
The systemic therapies which may modulate the pattern of immune dysregulation seen in HIV-1 disease may be beneficial in the pruritus seen in late-stage patients.
Smith
K J
KJ
Department of Dermatology, National Naval Medical Center, Bethesda, MD 20889-5600, USA.
Skelton
H G
HG
Yeager
J
J
Lee
R B
RB
Wagner
K F
KF
D000279:Administration, Cutaneous; D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000982:Antipruritics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016207:Cytokines / Q000276:immunology; D018450:Disease Progression; D004316:Doxepin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003875:Drug Eruptions / Q000150:complications; D004643:Emollients / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D005938:Glucocorticoids; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006679:HIV Seropositivity; D015497:HIV-1; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007213:Indomethacin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010431:Pentoxifylline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010787:Photosensitivity Disorders / Q000150:complications; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D012871:Skin Diseases / Q000150:complications; D012874:Skin Diseases, Infectious / Q000150:complications; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000982:Antipruritics; D016861:Cyclooxygenase Inhibitors; D016207:Cytokines; D004643:Emollients; D005938:Glucocorticoids; D010726:Phosphodiesterase Inhibitors; D004316:Doxepin; D014221:Triamcinolone; D006919:Hydroxyzine; D010431:Pentoxifylline; D007213:Indomethacin