Porphyria cutanea tarda associated with the acquired immune deficiency syndrome

Abstract

Three male subjects with cutaneous symptoms and biochemical signs typical of porphyria cutanea tarda (PCT) developed acquired immune deficiency syndrome (AIDS). All three were in a classic high risk group for the latter disease and developed a typical progressive illness. Two patients succumbed to opportunistic infections; the third is alive but critically ill. The symptomatic prodrome of AIDS developed concurrently with or followed the onset of symptoms of PCT in all three individuals. PCT and AIDS are both uncommon disorders; their association in three patients is thus of inherent clinical interest. If this association is not coincidental, it raises the possibility that the occurrence of photosensitivity, skin lesions, and evidence of biochemical changes characteristic of PCT may, in certain patients at risk for AIDS, presage the subsequent full clinical expression of the latter disease.

Immune activation and the anaemia associated with chronic inflammatory disorders

“…The negative correlation between EPO and haemoglobin levels can be explained by upregulation of EPO production by low haemoglobin levels and hypoxia (17,18). This sequence of events (Table 1) is supported by the finding that also the concentration of total porphyrins was found increased in patients with HIV infection and with other chronic inflammatory disorders (39,40). Moreover, a positive correlation exists between Table 1.…”

Heme inhibits human immunodeficiency virus 1 replication in cell cultures and enhances the antiviral effect of zidovudine.

“…It should be noted that aberrations of heme metabolism, manifest as a porphyric clinical syndrome, have been identified by Wissel et al (31) and other groups (32,33) in some AIDS patients. Further, erythropoietin has been shown to have a beneficial effect on the anemia associated with this disorder (34,35).…”

Porfiria cutânea tardia

“…72 There is also slight increase in the prevalence of hepatitis B. 73 The association of HIV with PCT was first recognized in 1987, 74 and in the early records, PCT usually occurred in the late phases of the infection. 75 Currently, in most cases reported, the diagnosis of HIV is concomitant to that of PCT; 76 therefore, ordering HIV sorology should be considered in all PCT patients.…”