Toenail onychomycosis in patients with acquired immune deficiency syndrome: treatment with terbinafine

Abstract

Skin infections caused by dermatophytes are one of the most frequent dermatological complications in patients with acquired immunodeficiency syndrome (AIDS) resulting from infection with human immunodeficiency virus (HIV). Tinea unguium associated with AIDS is characterized by being clinically more aggressive and therapeutically more difficult to treat than in the general population. Terbinafine is considered to be a first-choice option for the treatment of dermatophyte onychomycosis in immunocompetent individuals. This drug has been used in a series of 21 HIV-positive patients diagnosed with tinea unguium for 1 year in the University Hospital La Paz, Madrid. All patients underwent a subsequent clinical follow-up for 6 months. The results showed a high percentage of clinical and mycological cures, as well as maintenance of the response after follow-up; no drug interactions or significant adverse effects related to the drug under study were recorded.

The prevalence of dermatophyte infection in patients infected with human immunodeficiency virus

“…Seborrheic dermatitis, the pathogenesis of which may be related to cutaneous infection with Malassezia furfur , is more common and often more severe in patients with HIV infection than in nonimmunosuppressed patients. HIV infection may be associated with an increased incidence of onychomycosis 7 or more aggressive disease 8 …”

Global perspectives for the management of onychomycosis

“…Interestingly, there have been reported cases of HIV‐positive patients cured for onychomycosis after their immune systems were restored by combined antiretroviral therapy or highly active antiretroviral therapy . It should be noted that fungal infections can spread faster in immunocompromised patients, and clinical presentations that are generally more difficult to treat are more frequently encountered in this subpopulation …”

Evaluation of improvement of onychomycosis in HIV‐infected patients after initiation of combined antiretroviral therapy without antifungal treatment

“…We assessed the severity of the nail involvement with the Onychomycosis Severity Index (OSI), which is a simple, objective and reproducible numeric tool . This scale rates as mild onychomycosis a score of 1–5 points, moderate or severe . We determined as the index nail the one that rated the highest score.…”