Can response of a pruritic papular eruption to antiretroviral therapy be used as a clinical parameter to monitor virological outcome?

Abstract

Background: A pruritic papular eruption (PPE) is a common skin manifestation observed in 12–46% of persons with HIV infection living in tropical countries. Objective: To determine whether PPE responds to HAART and whether monitoring PPE severity could be used as a clinical marker to predict virological outcome in resource limited settings where viral load testing is not available. Methods: The study enrolled 53 patients with PPE for at least 1 month before starting a first-line HAART regimen as part of a prospective study. CD4 cell count and viral load were measured at enrolment and every 3 months. A scoring system was developed to evaluate the PPE severity by asking two questions. Over the last month how itchy has your skin been? Over the last month how has itching interfered with your sleep? Results: Median CD4 cell count was 15 cells/ml and median viral load 268 663 copies/ ml. All patients initiated a regimen containing a nonnucleoside reverse transcriptase inhibitor. Mean PPE score declined from 3.9 at enrolment to 0.1 at 24 months. In 37 (86%) of the 43 patients with at least 6 months of follow-up data, the PPE disappeared and never returned. Patients with viral load >400 copies/ml at months 9 and/or 12 had significantly higher PPE scores at months 9 to 12 than the patients with <400 copies/ml. Conclusions: In most patients, PPE disappears during HAART and PPE severity scores were higher in patients whose first-line HAART failed to control plasma viral load.