title: Clinical and epidemiologic characterization of photosensitivity in HIV-positive individuals.
abstract: BACKGROUND
  An increased prevalence and severity of cutaneous photosensitivity has been recognized in association with human immunodeficiency virus (HIV) infection. However, this disorder remains poorly characterized in terms of its epidemiology, predisposing factors, clinical, and environmental associations.
  
  
  METHODS
  To define the risk factors associated with the presence of photosensitivity among HIV-positive individuals, a cross-sectional study of 631 primary patient visits to an urban HIV Dermatology clinic between January 1997 and August 2001, inclusive, was conducted. A multivariate model was fit to estimate adjusted odds ratios for risk factors associated with photosensitivity diagnosis. Subsequently, a case-series of the patients with photosensitivity was reported.
  
  
  RESULTS
  The overall prevalence of photosensitivity was 5.4%, while African-Americans (AA) exhibited a prevalence of 7.3%. In the multivariate model, using highly active anti-retroviral therapy (HAART) (OR=2.82, 95% CI: 1.13, 7.03) and being AA (OR=6.68, 95% CI: 1.56, 28.65) significantly increased the odds of photosensitivity. Patients with photosensitivity were more likely to present during periods of higher ultraviolet (UV) index (P=0.08). Two distinct clinical morphologies were noted: lichenoid and non-lichenoid, eczematous. Sub-morphologies in the non-lichenoid group were suggestive of differences in immunologic profile and estimated UV exposure.
  
  
  CONCLUSIONS
  Photosensitivity associated with HIV infection is an increasingly recognized dermatologic condition with a heterogeneous clinical presentation. AA ethnicity and HAART were independent indicators for the diagnosis of photosensitivity, whereas CD4+ and UV exposure had non-significant associations. The subtleties in these and other clinical variables may directly aid in the recognition and diagnosis of this poorly characterized disorder.
authors.affiliation: Department of Dermatology, Johns Hopkins University, 550 N Caroline Street, Suite 1002, Baltimore, MD 21287-0900, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Bilu
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Mamelak
authors.forename: Ruby H-N
authors.initials: RH
authors.lastname: Nguyen
authors.forename: Pedro C
authors.initials: PC
authors.lastname: Queiroz
authors.forename: Jeanne
authors.initials: J
authors.lastname: Kowalski
authors.forename: Warwick L
authors.initials: WL
authors.lastname: Morison
authors.forename: Ciro R
authors.initials: CR
authors.lastname: Martins
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors