title: Undetectable HIV-1 viral load in the fluid of bullous skin lesion in a patient receiving highly active antiretroviral therapy.
abstract: Health-care workers may be exposed to bullous fluid while caring for bullous skin diseases in HIV-infected patients. Given that bullous fluid is a filtrate of plasma, it may be assumed that HIV viral load (VL) in bullous fluid is close to plasma VL. This was documented in a patient who had discontinued antiretroviral therapy because of nevirapine-associated toxic epidermal necrolysis, but no data are available in patients receiving antiretrovirals. An HIV-infected woman was admitted for leg cellulitis with a large bullous lesion. Her plasma HIV RNA had been undetectable for two years under the combination of efavirenz and boosted lopinavir. Bullous fluid analysis revealed undetectable HIV-1 RNA, while efavirenz and lopinavir concentrations were 1.4 and 3.4 microg/mL, respectively. The ratio of bullous fluid/plasma concentrations was 0.74 for efavirenz and 0.26 for lopinavir. These data may help us evaluate the need for antiretroviral prophylaxis after occupational exposure to bullous lesions fluid.
authors.affiliation: Department of Infectious Diseases, Pontchaillou University Hospital, Rennes, France. pierre.tattevin@chu-rennes.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.forename: Anne
authors.initials: A
authors.lastname: Maillard
authors.forename: Olivier
authors.initials: O
authors.lastname: Tribut
authors.forename: Emilie
authors.initials: E
authors.lastname: Saïkali
authors.forename: Cedric
authors.initials: C
authors.lastname: Arvieux
authors.forename: Christian
authors.initials: C
authors.lastname: Michelet
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D012367:RNA, Viral / Q000032:analysis*; D012867:Skin / Q000737:chemistry / Q000821:virology*; D019562:Viral Load
chemical_list: D012367:RNA, Viral