Human Immunodeficiency Virus and the Skin: Selected Controversies.

Abstract

Acquired immunodeficiency syndrome was first recognized as a new disease in 1981 because of the unusual association of Kaposi's sarcoma and Pneumocystis carinii pneumonia in young men. The skin remains one of the most important clinical markers for acquired immunodeficiency syndrome, now recognized as the end stage of infection with the human immunodeficiency virus (HIV). Indeed, an urticarial viral exanthem appearing during seroconversion may allow early identification of newly infected individuals who might benefit from administration of antiviral therapy during plasma viremia. The "asymptomatic HIV infection" is often accompanied by multiple skin complaints, which commonly include xerosis, pruritus, psoriasis/seborrheic dermatitis, and pruritic papular eruptions, the cause of which remains controversial. Psoriasis and Kaposi's sarcoma lesions share features including angiogenesis, dermal dendrocytes infected with HIV, and epidermal hyperproliferation, and are manifested by mice transgenic for HIV provirus or Tat-ltr. Changes in the immune system including T-cell function, antigen response, and shifting cytokine expression as well as a propensity for autoimmune reactions must underlie the skin immunodysfunction occurring in the setting of HIV infection. One of the most unsettling controversies suggested by in vitro data is that ultraviolet light, an effective therapy for HIV-related skin disorders, may actually activate the virus.

Regressão de psoríase em paciente HIV-positivo após terapia anti-retroviral

“…They continue to be one of the most important clinical markers of the syndrome, 1 serving as a predictive factor of the infection 5 or sign of advanced disease. Its frequency and gravity increases as the disease progresses, and the immune function diminishes.…”

“…16 Side effects of Etretinate include migraine and alterations of hepatic enzymes. 3 Although exactly how the use of the ultraviolet light (UV) alters the natural course of the infection 17 has not been fully clarified and no significant increase in the viremia was observed during and after treatment, 14 it is believed that activation of the virus can occur, 1 as well as an increase in the viral load and decrease in the CD4 count, with potentiation of opportunist infections and acceleration of the Aids. 17 Experiments in animal models have demonstrated that UVB and PUVA are immunosuppressants due to the stimulation of the replication or activation of HIV.…”

“…1 Today, it is considered that some million people are infected by HIV in the USA. 2 Psoriasis is a chronic dermatosis that affects approximately 1.5 to 2%3 of the world population and 1.3 to crônica que afeta cerca de 1,5 a 2% 3 da população mundial e 1,3 a 5% 3,4 dos pacientes infectados com HIV, sendo considerada sinal de mau prognóstico.…”

Normal skin of HIV-infected individuals contains increased numbers of dermal CD8 T cells and normal numbers of Langerhans cells

“…Suggestive of both local permissiveness and responsiveness to the presence of HIV, a change in the cutaneous environment also appears to take place. As such, an dysregulation of the skin immune system (SIS) could be the prime reason for the increasing prevalence of skin disorders in HIV+ individuals (4)(5)(6)(7). However, few studies have been conducted on the SIS of HIV+ patients, in whom, similar to what occurs in other specialized lymphoid systems, changes in the immune cells associated with the SIS would be predictable (8)(9)(10).…”

Effect of UV-B Phototherapy on Plasma HIV Type 1 RNA Viral Level: A Self-controlled Prospective Study

“…[1][2][3][4][5][6] Ultraviolet-B light from artificial and natural sources was first shown to enhance HIV growth in experiments using cell culture systems. 7,8 In vivo studies using transgenic mice that express the HIV longterminal-repeat promoter linked to reporter genes further indicated that sunlight and artificial UV-B in doses as low as 9 mJ/ cm 2 can potently stimulate viral replication in the skin.…”