title: Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era.
abstract: BACKGROUND
  Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure.
  
  
  OBJECTIVE
  To determine factors associated with PPE in HIV-infected persons receiving ART.
  
  
  METHODS
  A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration.
  
  
  RESULTS
  Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL(-1) (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8(+) T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01).
  
  
  CONCLUSIONS
  Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions.
authors.affiliation: Department of Dermatology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2WB, U.K.
authors.forename: S L
authors.initials: SL
authors.lastname: Chua
authors.forename: E H
authors.initials: EH
authors.lastname: Amerson
authors.forename: K S
authors.initials: KS
authors.lastname: Leslie
authors.forename: T H
authors.initials: TH
authors.lastname: McCalmont
authors.forename: P E
authors.initials: PE
authors.lastname: Leboit
authors.forename: J N
authors.initials: JN
authors.lastname: Martin
authors.forename: D
authors.initials: D
authors.lastname: Bangsberg
authors.forename: T A
authors.initials: TA
authors.lastname: Maurer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001733:Bites and Stings / Q000150:complications; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011537:Pruritus / Q000209:etiology*; D012367:RNA, Viral / Q000378:metabolism; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral