Photosensitive disorders in HIV

Koch, Karen

doi:10.4102/sajhivmed.v18i1.676

Cited by 13 publications

(19 citation statements)

References 18 publications

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“…Estima-se que em algum momento da sua evolução 5% dos doentes com infecção por VIH apresentem fotossensibilidade. 3 Habitualmente associada a fármacos utilizados no seu tratamento, tem também sido descrita sob a forma de dermatoses fotossensíveis ou, mais raramente, como manifestação inicial da infeção pelo vírus. 4 Os fármacos mais frequentemente implicados compreendem os agentes anti-retrovirais, destacando-se o efavirenz e o saquinavir, trimetoprim-sulfametoxazol, anti-inflamatórios não esteroides, cetoconazol, azitromicina e dapsona.…”

Section: Discussionunclassified

“…2 O reconhecimento de um padrão de fotossensibilidade pressupõe o atingimento de áreas foto-expostas como a face, pavilhões auriculares, região cervical posterior, "V" do decote e dorso das mãos, poupando as áreas sombra, como a região retro-auricular, pregas nasogenianas, pálpebras superiores e zona submentoniana. 3 Revista SPDV 78(3) 2020; Fotossensibilidade como manifestação inicial de Iinfeção por vírus da imunodeficiência humana; Maria Relvas, Francisca Morgado, Hugo Oliveira, Margarida Gonçalo.…”

Section: Introductionunclassified

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Fotossensibilidade como Manifestação Inicial de Infeção por Vírus da Imunodeficiência Humana

Relvas

Morgado

Oliveira

et al. 2020

SPDV

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As reações de fotossensibilidade caracterizam-se por uma resposta alterada à radiação não-ionizante, apresentando diversos padrões morfológicos, que refletem as suas diferentes etiologias. Relatamos o caso de um doente observado por dermatose fotossensível refratária a múltiplos tratamentos. Excluídas possíveis causas exógenas e após demonstração de uma dose de eritema mínimo diminuída para UVB, o estudo analítico com vista a iniciar azatioprina revelou serologia positiva para VIH, revelando elevada carga viral e contagens TCD4+ reduzidas. Neste seguimento, iniciou de imediato terapêutica anti-retroviral, com resolução rápida e completa do quadro. Estima-se que 5% dos doentes VIH-positivos apresentem fotossensibilidade em algum momento da sua evolução. Mais frequentemente associada a fármacos utilizados no tratamento, a sensibilidade à luz solar tem também sido ocasionalmente descrita como manifestação inicial da infeção, como no presente caso. Os autores pretendem alertar para a associação entre fotossensibilidade e infeção por VIH que, embora tenha vindo a ser crescentemente reconhecida, está ainda pouco caracterizada.

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Section: Discussionunclassified

Section: Introductionunclassified

Fotossensibilidade como Manifestação Inicial de Infeção por Vírus da Imunodeficiência Humana

Relvas

Morgado

Oliveira

et al. 2020

SPDV

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“…However, in the context of HIV infections, it is not always simple to distinguish cutaneous manifestations related to the disease itself from those induced by the drug [ 3 , 53 , 54 , 55 ]. Indeed, nearly 5% of patients with HIV suffer from some form of photosensitive dermatitis, including PSDs-induced reactions, actinic prurigo, chronic actinic dermatitis, lichenoid photoeruptions, porphyria cutanea tarda, pseudoporphyria, photoaggravated granuloma annulare, and actinic lichenoid leukomelanoderma [ 56 ]. Moreover, HIV patients are overall more susceptible to drug reactions than the general population, due to multiple factors among which there are polypharmacy, slow acetylator status, relative glutathione deficiency, and latent Herpesviridae infections [ 55 ].…”

Section: Photosensitive Drugsmentioning

confidence: 99%

Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations

et al. 2020

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Photosensitivity induced by drugs is a widely experienced problem, concerning both molecule design and clinical practice. Indeed, photo-induced cutaneous eruptions represent one of the most common drug adverse events and are frequently an important issue to consider in the therapeutic management of patients. Phototoxicity and photoallergy are the two different pathogenic mechanisms involved in photosensitization. Related cutaneous manifestations are heterogeneous, depending on the culprit drug and subject susceptibility. Here we report an updated review of the literature with respect to pathogenic mechanisms of photosensitivity, clinical manifestations, patient management, and prediction and evaluation of drug-induced photosensitivity. We present and discuss principal groups of photosensitizing drugs (antimicrobials, nonsteroidal anti-inflammatory drugs, anti-hypertensives, anti-arrhythmics, cholesterol, and glycemia-lowering agents, psychotropic drugs, chemotherapeutics, etc.) and their main damage mechanisms according to recent evidence. The link between the drug and the cutaneous manifestation is not always clear; more investigations would be helpful to better predict drug photosensitizing potential, prevent and manage cutaneous adverse events and find the most appropriate alternative therapeutic strategy.

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“…The range of values for isoniazid exposure assumes 80% IPT uptake among PLHIV in the target population (based on unpublished Malawi MoH program data) and a conservative estimate for HIV prevalence among dermatology clinic attendees of 15%−20%. We base the latter estimate on known HIV prevalence (∼10% for rural and ∼14% for urban Malawi) (37) and the expectation that the rate of HIV among skin clinic attendees is probably higher than the general population (38,39). We do not need to account for loss to follow-up because the primary measures of association derive from data collected at enrollment.…”

Section: Niacin Metabolite Assaymentioning

confidence: 99%

Protocol for a Case-Control Study to Investigate the Association of Pellagra With Isoniazid Exposure During Tuberculosis Preventive Treatment Scale-Up in Malawi

Nabity

Mponda

Gutreuter

et al. 2020

Front. Public Health

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Background: Pellagra is caused by niacin (vitamin B3) deficiency and manifested by a distinctive dermatitis. Isoniazid is critical for treating tuberculosis globally and is a component of most regimens to prevent tuberculosis. Isoniazid may contribute to pellagra by disrupting intracellular niacin synthesis. In 2017, Malawian clinicians recognized a high incidence of pellagra-like rashes after scale-up of isoniazid preventive treatment (IPT) to people living with HIV (PLHIV). This increase in pellagra incidence among PLHIV coincided with a seasonal period of sustained food insecurity in the region, which obscured epidemiological interpretations. Although isoniazid has been implicated as a secondary cause of pellagra for decades, no hypothesis-driven epidemiological study has assessed this relationship in a population exposed to isoniazid. We developed this case-control protocol to assess the association between large-scale isoniazid distribution and pellagra in Malawi.Methods: We measure the relative odds of having pellagra among isoniazid-exposed people compared to those without exposure while controlling for other pellagra risk factors. Secondary aims include measuring time from isoniazid initiation to onset of dermatitis, comparing niacin metabolites 1-methylnicotinamide (1-MN), and l-methyl-2-pyridone-5-carboxamide (2-PYR) in urine as a proxy for total body niacin status among subpopulations, and describing clinical outcomes after 30-days multi-B vitamin (containing 300 mg nicotinamide daily) therapy and isoniazid cessation (if exposed). We aim to enroll 197 participants with pellagra and 788 age- and sex-matched controls (1:4 ratio) presenting at three dermatology clinics. Four randomly selected community clinics within 3–25 km of designated dermatology clinics will refer persons with pellagra-like symptoms to one of the study enrollment sites for diagnosis. Trained study dermatologists will conduct a detailed exposure questionnaire and perform anthropometric measurements. A subset of enrollees will provide a casual urine specimen for niacin metabolites quantification and/or point-of-care isoniazid detection to confirm whether participants recently ingested isoniazid. We will use conditional logistic regression, matching age and sex, to estimate odds ratios for the primary study aim.Discussion: The results of this study will inform the programmatic scale-up of isoniazid-containing regimens to prevent tuberculosis.

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Photosensitive disorders in HIV

Cited by 13 publications

References 18 publications

Fotossensibilidade como Manifestação Inicial de Infeção por Vírus da Imunodeficiência Humana

Fotossensibilidade como Manifestação Inicial de Infeção por Vírus da Imunodeficiência Humana

Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations

Protocol for a Case-Control Study to Investigate the Association of Pellagra With Isoniazid Exposure During Tuberculosis Preventive Treatment Scale-Up in Malawi

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