PRURITUS IN HIV-1 DISEASE - THERAPY WITH DRUGS WHICH MAY MODULATE THEPATTERN OF IMMUNE DYSREGULATION

Background: Pruritus in HIV-1+ patients is common and increases with d isease progression. The causes of pruritus are numerous including xero sis, drug and photoeruptions, follicular and papular eruptions as well as infestations and infections by a wide range of organisms, One othe r possible factor contributing to pruritus is the pattern of immune dy sregulation. With advancing HIV-1 disease there is Th1 to Th2 cytokine switching. Methods: After some positive results with prostaglandin in hibitors, we undertook a study in which we randomly placed patients on four different forms of therapy for their pruritus. The therapies inc luded hydroxyzine with or without doxepin at night, pentoxifylline, in domethacin and topical moisturization with medium-strength topical ste roids. All patients were evaluated for both subjective relief as well as side effects. Results: Patients placed on indomethacin obtained rel ief more consistently and more completely. Patients on pentoxifylline had the fewest side effects of all oral therapies, Patients on antihis tamines with or without doxepin had the highest incidence of side effe cts, although more of these patients reported a greater degree of reli ef than patients on pentoxifylline. All patients on oral therapy overa ll had greater relief than patients using topical steroids, Conclusion : The systemic therapies which may modulate the pattern of immune dysr egulation seen in HIV-1 disease may be beneficial in the pruritus seen in late-stage patients.