INCREASED DRUG-REACTIONS IN HIV-1-POSITIVE PATIENTS - A POSSIBLE EXPLANATION-BASED ON PATTERNS OF IMMUNE DYSREGULATION SEEN IN HIV-1 DISEASE

Drug reactions are common in HIV-1 disease, with the incidence having been reported to increase with increasing stage and with CD4+ T-cell c ounts below 200/mu l. However, there have been numerous reports of pat ients in which rechallenge, dosing changes or continued therapy have r esulted in no recurrence or else clearing of the eruption. We followed 974 HIV-1-positive patients for 46 months as a part of a military stu dy of HIV-1 disease. Within this group there were a total of 283 drug eruptions, with cutaneous manifestations in 201 patients in which clin ical characteristics were noted and 86 patients in which cutaneous bio psies were performed. Serological evidence of reactivation or acute Ep stein-Barr virus (EBV) or cytomegalovirus (CMV) infections were also n oted, as well as peripheral eosinophilia. The incidence of drug erupti ons significantly increased with increasing Walter Reed stage and decr easing CD4 counts and CD4/CD8 ratio, as well as with increasing age an d in patients with increased numbers of other dermatological diagnoses . In addition, white patients had significantly more drug eruptions th an did black. Serological or culture evidence of acute or reactivated EBV or CMV was significantly increased in patients with drug eruptions . The majority of the eruptions were maculopapular or morbilliform wit h a predominantly perivascular mononuclear cell infiltrate.