CUTANEOUS DISEASE AND DRUG-REACTIONS IN HIV-INFECTION

Background. Skin diseases, including adverse reactions to drugs, are t hought to be more common among patients with human immunodeficiency vi rus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) than among other persons. These skin conditions can be disabling or di sfiguring and may require discontinuation of essential drugs. Methods. We identified 684 HIV-infected members of a 265,000-member health mai ntenance organization and reviewed their medical records to determine the frequency of dermatologic diagnoses from April 1, 1988, through Ja nuary 15, 1991. We compared the rates of visits per year for skin cond itions by HIV-infected men, 20 to 49 years of age, with those by non-H IV-infected men. We used an automated prescription data base to quanti fy exposures to drugs. Results. Of the 684 HIV-infected patients, 540 (79 percent) were given one or more dermatologic diagnoses, for a tota l of 2281 diagnoses, including 188 cutaneous reactions to drugs. There were 43 hospitalizations for cellulitis (n = 15), cutaneous drug reac tions (n = 13), or other skin problems. As compared with non-HIV-infec ted men, the men with AIDS had visit rates that were at least 5 times higher for 18 of the 20 most common infectious and inflammatory skin c onditions and at least 15 times higher for 9 conditions. Drugs with th e highest rate of cutaneous reactions (per 1000 courses) included trim ethoprim-sulfamethoxazole (149), sulfadiazine (200), trimethoprim-daps one (156), and aminopenicillins (93). The number of diagnoses of skin conditions increased according to the stage of disease: it was lowest in patients immediately before the documentation of HIV infection and highest in patients with a diagnosis of AIDS. Conclusions. Cutaneous d iseases, including drug reactions, are extremely common in patients wi th HIV infection, and their incidence increases as immune function det eriorates.