title: Initiation of antiretroviral therapy in HIV-infected adults with skin complaints in northern Tanzania.
abstract: Abnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)-infected persons globally. A prospective cohort study of HIV-infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV-infected subjects presenting with skin complaints, who met criteria for ART initiation, were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed, and CD4(+) cell counts and plasma HIV RNA levels were measured. All subjects received a fixed-dose combination of stavudine, lamivudine, and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow-up. Median baseline CD4(+) cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log10 copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months, 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution, the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3, which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months, the median CD4(+) cell count had increased to 474 cells/μl, and plasma HIV RNA levels were <400 copies/ml in 85 (99%) subjects. Patients with HIV infection with skin complaints experienced marked clinical improvements following ART initiation.
authors.affiliation: Regional Dermatology Training Center, Moshi, Tanzania; Kilimanjaro Christian Medical Center, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Daudi R
authors.initials: DR
authors.lastname: Mavura
authors.forename: E John
authors.initials: EJ
authors.lastname: Masenga
authors.forename: Eli
authors.initials: E
authors.lastname: Minja
authors.forename: Henning
authors.initials: H
authors.lastname: Grossmann
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000627:therapeutic use; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000188:drug therapy* / Q000821:virology*; D018119:Stavudine / Q000627:therapeutic use; D013636:Tanzania; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine