HIV Rash

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HIV Rash
HIV Rash

Rashes and Other Skin Conditions Related to H.I.V. Infection and A.I.D.S.

HIV Rash
HIV Rash

The human immunodeficiency virus is a rather insidious enemy normally waging a slow undercover war against the body’s natural defences often with no outward signs or symptoms of any note for many years. The skin however frequently becomes affected and rashes and other conditions are frequently encountered varying from being a mild irritation to a serious life-threatening condition. Such skin conditions can provide vital clues about the progress of any infection and enable a suitable treatment regime to be formulated.

In order to fully appreciate the full significance of any skin condition in an H.I.V. patient, it is first necessary to understand the normal progression of this infection and it is normally considered to have three distinct stages as follows:

Stage 1

Stage 1 is normally described as being an acute H.I.V. infection and this is the period immediately following the initial infection. The HIV virus is present in the bloodstream in high numbers and it triggers the body’s normal immune responses resulting in a fall in the number of white blood cells including a type of T4 cell known as a CD4 helper lymphocyte cell. This stage usually results in a flu-like illness most commonly around two to four weeks after the initial infection was contracted. A characteristic rash is also usually present with small raised red bumps, although with dark skin, it may have a purple hue. The rash is very itchy and can appear on any part of the body but is most commonly seen on the chest and face with the hands and feet sometimes being affected.

HIV Rash on Back
HIV Rash on Back

For anyone who may have been exposed to the possibility of H.I.V. infection, this is a serious warning signal. This is the most infectious stage of this disease when it is most likely to be transmitted but the rash itself is not a source of infection. So this rash, often accompanied by fever, a headache and general feeling of being unwell should certainly receive medical attention including an H.I.V. test. It should be remembered however that almost all viruses have a tendency to produce skin rashes with some people being more susceptible than others and the vast majority of rashes have absolutely no connection with H.I.V. infections, many being simply described as non-specific viral rash.

Stage 2

Even without treatment, the initial HIV rash is a fairly short-lived condition with an apparently full recovery soon following but this is the stage known as a chronic H.I.V. infection. This latent, or asymptomatic phase would normally last for around ten to twelve years and this is the time when the virus continues to damage the body’s immune system. The way in which this happens is complex but a simplified way of looking at it is that the H.I.V. virus not only damages the body tissues but it actually manages to infiltrate the CD4 cells by inserting its own R.N.A. (half of D.N.A.) into these cells mutating them into a form which simply no longer has the ability to destroy infections. Over time, the number of effective CD4 cells decreases as the mutant CD4 cells increase. This results in the body’s immune system becoming increasingly weakened seriously damaging its ability to fight off infections. With early diagnosis and the use of antiretroviral therapy, this process can be slowed down to such an extent that many patients can look forward to leading a fairly normal existence with a normal or near normal lifespan.

Stage 3

Unfortunately, the disease may progress to the third stage when the immune system is seriously compromised. When the CD4 cell count falls to a figure of less than 200 (compared to a normal adult level of 500 – 1,600) and the patient has contracted an opportunistic infection such as pneumonia, cancer or tuberculosis, a diagnosis of A.I.D.S. is usually given with a prognosis of survival for around three years. Various factors affect the rate of the progression of the disease including whether early diagnosis and treatment have been carried out, age, previous medical history especially whether there have been previous illnesses such as tuberculosis, hepatitis C or other sexually transmitted diseases.

Skin Conditions

AIDS / HIV Rash

Although the terms AIDS rash or HIV rash are commonly used, only the initial rash during the first stage of infection is directly caused by the virus. Most other skin conditions are considered to be opportunistic infections due to the increasingly compromised immune system. Although any skin problem may be encountered, some of the most frequently seen are as follows:-

Generalised Infections:

Xerosis – Abnormally dry skin.

Atopic dermatitis

Prurigo Nodularis – Indicating a very compromised immune system.

Eosino Folliculitis – Seen in later stages of the disease.

Seborrheic Dermatitis – Areas of flaky skin.

Psoriasis

Viral Infections:

Warts – Can appear anywhere on the body and can sometime resemble malignancies so biopsies are usually recommended.

Herpes Zoster – Although normally associated with chickenpox and shingles, in immunocompromised patients this infection may affect the eye or even the brain in the form of herpes meningoencephalitis.

Herpes Simplex 1 – The common cold-sore virus frequently appears when the immune system is depressed and the sores can spread rapidly.

Herpes Simplex 2 – The genital form of herpes is also more likely to appear or recur when an H.I.V. infection is present.

Molluscum Contagiosum – This is characterised by the presence of small firm raised papules and it can occur anywhere on the body.

Oral Hairy Leukoplakia – White lesions occur almost exclusively on the sides of the tongue. It is caused by the same virus as that responsible for glandular fever and following an earlier infection the virus lies dormant in the body only to reappear when the body’s immune system is weakened.

Bacterial Infections:

Stapphylococcus Aureus – May sometimes progress into impetigo with pustules and may resemble Kaposi Sarcoma or nodular melanoma.

Fungal Infections:

Thrush – Typically a white covering of the tongue.

Tinea – This group includes infections such as athlete’s foot and ringworm.

Parasitic Infections:

Scabies -This condition is due to the presence of the microscopic scabies mite which, although a usual inhabitant of healthy skin in small numbers, can be found in extremely high numbers where the immune system is compromised.

Skin Tumours:

Kaposi Sarcoma – This form of cancer is now known to be caused by a viral infection and several differing types of Kaposi sarcoma exist. It has for many years been regarded as one of the principal indicators and defining factors for A.I.D.S. diagnosis as its appearance almost always coincides with a very low white cell count. Although mainly known as a skin condition, Kaposi Sarcoma can also affect sites within the body including blood vessels and lymph nodes. Methods of treatment depend on whether lesions are confined to the skin surface. Highly active antiretroviral therapy (H.A.A.R.T.) has been particularly effective in many cases.

Other Skin Conditions:

Although the above skin conditions are those most commonly encountered in cases of H.I.V. infections and A.I.D.S., it must be remembered that many other skin problems may also appear and, in general, the severity of any such ailment will almost always be greater when the immune system is ineffective and treatment more difficult.

HIV Rash on Ankle
HIV Rash on Ankle

HIV Rash Treatment / AIDS Related Skin Conditions

The treatment of an AIDS rash and most of these skin conditions involves at least some topical treatment with over-the-counter or prescription products such as hydrocortisone cream. Some rashes are aggravated by environmental conditions and it is usually advisable to avoid heat, direct sunlight and hot water. It is also useful to check whether there have been any recent changes such as medication, toiletries or foods which could have triggered a reaction. The main way to avoid skin problems is to keep the body’s immune system in the best possible condition. Modern drugs can be extremely successful in this respect and there are six different classes of drugs used for this purpose:

  • Protease inhibitors

  • Fusion inhibitors

  • Nucleoside reverse transcriptase inhibitors

  • Non-nucleoside reverse transcriptase inhibitors

  • CCR5 antagonists

  • Integrase stand transfer inhibitors

Many of these drugs have increased effectiveness when used in combination with others and a typical treatment programme will often involve a combination of three different drugs from at least two different classes.

Some of the drugs used however do come with some serious side effects and ironically three classes of drugs are known to actually cause skin rashes, these being:

  • Non-nucleoside reverse transcript inhibitors

  • Nucleoside reverse transcript inhibitors

  • Protease inhibitors

The most common drug induced rashes are caused by Nevirapine (Viramune) (NNRTI), Abacavir (Ziagen) (NRTI) and Amprenavir (PI).

The problem of skin rashes due to medication should not be underestimated and a rare but potentially very serious condition due to drugs is Stevens-Johnson Syndrome which results in a rapidly developing rash, blisters on the skin and mucous membranes, fever and swelling of the tongue. When this covers 30% of the body it becomes toxic epidermal necrolysis.

So rashes and other skin problems are an intrinsic part of any H.I.V. infection and it is estimated that between 85 and 90% of patients will suffer from such conditions at some time. Modern treatments have revolutionised the way that this condition is managed but great care needs to be taken to minimise any potential side-effects of these powerful drugs.

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