Background Skin diseases, including adverse reactions to drugs,are thought to be more common among patients with human immunodeficiencyvirus (HIV) infection and the acquired immunodeficiency syndrome(AIDS) than among other persons. These skin conditions can bedisabling or disfiguring and may require discontinuation ofessential drugs.
Methods We identified 684 HIV-infected members of a 265,000-memberhealth maintenance organization and reviewed their medical recordsto determine the frequency of dermatologic diagnoses from April1, 1988, through January 15, 1991. We compared the rates ofvisits per year for skin conditions by HIV-infected men, 20to 49 years of age, with those by non-HIV-infected men. We usedan automated prescription data base to quantify exposures todrugs.
Results Of the 684 HIV-infected patients, 540 (79 percent) weregiven one or more dermatologic diagnoses, for a total of 2281diagnoses, including 188 cutaneous reactions to drugs. Therewere 43 hospitalizations for cellulitis (n = 15), cutaneousdrug reactions (n = 13), or other skin problems. As comparedwith non-HIV-infected men, the men with AIDS had visit ratesthat were at least 5 times higher for 18 of the 20 most commoninfectious and inflammatory skin conditions and at least 15times higher for 9 conditions. Drugs with the highest rate ofcutaneous reactions (per 1000 courses) included trimethoprim-sulfamethoxazole(149), sulfadiazine (200), trimethoprim-dapsone (156), and aminopenicillins(93). The number of diagnoses of skin conditions increased accordingto the stage of disease: it was lowest in patients immediatelybefore the documentation of HIV infection and highest in patientswith a diagnosis of AIDS.
Conclusions Cutaneous diseases, including drug reactions, areextremely common in patients with HIV infection, and their incidenceincreases as immune function deteriorates.
Source Information
From the Department of Dermatology, Beth Israel Hospital (S.A.C., R.S.S.); Harvard Community Health Plan (R.A.J.); Channing Laboratory Department of Medicine, Brigham and Women's Hospital (R.P.), and Harvard Medical School (S.A.C., R.A.J., R.P., R.S.S.) -- all in Boston.
Address reprint requests to Dr. Stern at the Department of Dermatology, Harvard Medical School, Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.
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