Cutaneous drug reactions in patients infected with human immunodeficiency virus

Abstract

Cutaneous adverse drug reactions (cADRs) are commonly seen in HIVinfected patients and must be carefully and expertly managed for the best possible outcomes to be realized. Although skin disorders have decreased in the highly active antiretroviral therapy (HAART) era, and newer pharmacogenetic tests have lessened the impact of at least one serious cutaneous adverse reaction (SCAR)-the abacavir hypersensitivity reaction-cADRs remain very important and challenging. Most cADRs are delayed hypersensitivity (Type IV) reactions. Lipoatrophy, lipohypertrophy, and retinoic acid Metabolism-Related dermal effects seen with some HIV-1 protease inhibitors are often stigmatizing and may lead to antiretroviral nonadherence or discontinuation. Stevens-Johnson syndrome/toxic epidermal necrolysis remain rare but have been described with most antiretroviral agents and especially with neviripine and Trimethoprim-Sulfamethoxazole (TMP-SMX). The ability to differentiate between the more common mild to moderate benign cADRs for which the implicated medication may often be safely continued or reintroduced from SCARs including Drug-Induced hypersensitivity syndromes (DIHS) such as those seen with TMP-SMX, abacavir, and non-nucleoside reverse transcriptase inhibitors, is critical as these cause significant morbidity and can worsen or be fatal on rechallenge.