DRUG ERUPTIONS IN HIV PATIENTS AFTER USIG DIFFERENT HIV MEDICINES

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Drug eruptions have been reported as the most common cause of erythroderma in patients infected with HIV. A study identified 177 cases of Steven-Johnson syndrome/toxic epidermal necrolysis from 2000-2010 and found a high proportion of the patients were infected with HIV in sub-Saharan Africa, with a high frequency of antiretroviral drugs as the cause.^[38] This elevated incidence of HIV patients with an adverse cutaneous drug eruption, including toxic epidermal necrolysis, may be due to a loss of skin-protective CD4⁺ CD25⁺ regulatory T cells.^[39]

As many as 65-70% of patients treated with trimethoprim-sulfamethoxazole forPneumocystis jiroveci pneumonia experience morbilliform eruptions within 7 days of starting the therapy. Reddish macules and papules may be generalized and can become permanent after the discontinuation of the therapy.

Sulfonamides may cause the following:

• Urticaria
• Erythema multiforme
• Toxic epidermal necrolysis
• Systemic reactions, including fever, leukopenia, thrombocytopenia, hepatitis, and nephritis

Toxic epidermal necrolysis has been reported with the following agents in patients with HIV:

• Fluconazole
• Clindamycin and other antibiotics
• Phenobarbital
• Chlormezanone

Fixed drug eruption has been reported in 2 patients receiving saquinavir, an HIV-1 protease inhibitor.