title: Treatment of Dermatological Conditions Associated with HIV/AIDS: The Scarcity of Guidance on a Global Scale.
abstract: Background. Skin diseases associated with Human Immunodeficiency Virus (HIV) infection are associated with significant morbidity and mortality. In resource-limited settings, nondermatologists and lay health care providers on the front line of HIV care provide much of the treatment for these conditions. Objective. To evaluate guidelines for treatment of HIV-related skin conditions and assess their accessibility, comprehensiveness, and quality of evidence employed. Methods. A review was undertaken of all national and society guidelines which included treatment information on the ten highest burden HIV-related skin conditions. The search strategy included gray and peer-reviewed literature. Results. Of 430 potential guidelines, 86 met inclusion criteria, and only 2 were written specifically to address HIV-related skin diseases as a whole. Treatment information for HIV-related skin conditions was embedded within guidelines written for other purposes, primarily HIV/AIDs treatment guidelines (49%). Development of guidelines relied either partially or completely on expert opinion (62%). Only 16% of guidelines used gradation of evidence quality and these were primarily from high-income countries (p = 0.001). Limitations. Due to the nature of gray literature, not all guidelines may have been identified. Conclusion. This review highlights the need for evidence-based summary guidelines that address treatment for HIV-related skin conditions in an accessible format.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Suchismita
authors.initials: S
authors.lastname: Paul
authors.affiliation: HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Evans
authors.affiliation: Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, CA, USA.
authors.forename: Toby
authors.initials: T
authors.lastname: Maurer
authors.affiliation: Department of Maternal, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Lulu M
authors.initials: LM
authors.lastname: Muhe
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Esther E
authors.initials: EE
authors.lastname: Freeman