title: Role of antiretroviral therapies in mucocutaneous manifestations in HIV-infected children over a period of two decades.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) infection causes a severe cellular immunodeficiency, which results in a greater susceptibility to infectious, inflammatory and malignant conditions. Among these, pathologies of the skin seem to be those most frequently observed in HIV+ patients. However, there are few reports on how antiretroviral therapy affects skin disorders in HIV-infected children.
  
  
  OBJECTIVE
  To study the incidence and prevalence of skin disorders in a cohort of HIV-infected children, in relation to the antiviral therapy [nontreated, monotherapy, combined therapy and highly active antiretroviral therapy (HAART)] received, and their impact on immunological and virological markers. The treatments were those available in different calendar periods in the history of antiviral treatment.
  
  
  METHODS
  A retrospective, observational study in a cohort of 210 HIV-infected children was carried out. These children were followed up every 3 months throughout 22 years. The viral load (HIV RNA copies mL(-1)) was quantified using reverse transcriptase-polymerase chain reaction and the viral phenotype of HIV-1 isolates was determined by in vitro culture. T-lymphocyte subsets in peripheral blood were quantified by flow cytometry.
  
  
  RESULTS
  Mucocutaneous manifestations were diagnosed in 17% of the untreated infected children. Of the treated children in different treatment periods, 22% in the monotherapy period, 25% in the combined therapy period but only 10% on HAART had some type of mucocutaneous manifestation, concordant with a higher number of CD4+ T cells, a lower viral load and less cytopathic virus in the last group. Mucocutaneous manifestations of infectious aetiology were most frequently observed; they were detected in 13% of the children during the first calendar period (untreated children), 16% during the second and third periods (monotherapy and combined therapy) and only 5% in the last period (HAART). Interestingly, syncytium-inducing virus was present in 69% of all children with mucocutaneous manifestations of infectious aetiology.
  
  
  CONCLUSIONS
  Only in the last calendar period (HAART) was a significant decrease observed in the prevalence of mucocutaneous manifestations with HIV infection associated with an increase in CD4+ T cells. In addition, we found a strong association between children who had mucocutaneous manifestations with an infectious aetiology and a more cytopathic (X4/SI) viral phenotype.
authors.affiliation: Division of Molecular Immunobiology, Laboratorio de Inmunobiología, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Seoane Reula
authors.forename: J M
authors.initials: JM
authors.lastname: Bellon
authors.forename: D
authors.initials: D
authors.lastname: Gurbindo
authors.forename: M A
authors.initials: MA
authors.lastname: Muñoz-Fernandez
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D015994:Incidence; D018655:Lymphocyte Count; D010641:Phenotype; D015995:Prevalence; D012189:Retrospective Studies; D017193:Skin Diseases, Viral / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents