THE SAFETY OF UVB PHOTOTHERAPY IN PATIENTS WITH HIV-INFECTION

Background: In patients with psoriasis and human immunodeficiency viru s type 1 (HIV-1) infection, therapeutic options may be limited by thei r potential immunosuppressive effects. UVB radiation can activate HIV- 1 gene expression in transgenic mice and in vitro. It is not known whe ther this viral activation leads to a clinically significant effect or if these findings can be extrapolated to humans. Objective: This stud y was performed to evaluate the safety of UVB light treatment in HIV-i nfected persons. Methods: We prospectively studied the effect of UVB p hototherapy on five HIV-infected patients with psoriasis and one with pruritus. A complete blood cell count with differential count, CD4+ an d CD8+ T-lymphocyte counts, serum beta2-microglobulin and HIV-1 p24 an tigen were obtained before UVB phototherapy and after 21 and 42 treatm ents. After every five treatments patients were evaluated for opportun istic infections, and psoriatic involvement was quantified with the Ps oriasis Area and Severity Index (PASI). Results: Cumulative UVB doses ranged from 3326 to 43,364 mJ/cm2. There were no statistically signifi cant changes in laboratory findings after 21 and 42 treatments. Of thr ee patients without detectable serum levels of HIV-1 p24 antigen befor e phototherapy, only one became positive after 42 treatments. None of the six subjects had an opportunistic infection or malignancy during p hototherapy. The PASI improved in all five patients with psoriasis, an d the other patient noticed decreased pruritus. Conclusion: Our result s suggest that UVB phototherapy is efficacious in HIV-1-infected patie nts with UVB-responsive dermatoses and is not associated with short-te rm changes in immune function.