Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era

S. L. Chua, E. H. Amerson, K. S. Leslie, T. H. McCalmont, P. E. Leboit, J. N. Martin, David Bangsberg, T. A. Maurer

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. Objectives To determine factors associated with PPE in HIV-infected persons receiving ART. Methods A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. Results Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL-1 (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8+ T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). Conclusions Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions. What's already known about this topic? Papular pruritic eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. PPE is characterized by symmetrically distributed itchy papules, worst on the extremities, with similar microscopic findings to insect bites or stings. What does this study add? Persistent or recurrent PPE in antiretroviral therapy (ART)-treated persons is associated with greater HIV RNA load at ART commencement but not during treatment. No association was found with CD4 count, CD4 gains and T-cell activation markers.

Original languageEnglish (US)
Pages (from-to)832-839
Number of pages8
JournalBritish Journal of Dermatology
Volume170
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Virus Diseases
HIV
Insect Bites and Stings
Therapeutics
CD4 Lymphocyte Count
Biopsy
Skin
Odds Ratio
RNA
T-Lymphocytes
Uganda
Viremia
Exanthema
Viral Load
Treatment Failure
Teaching Hospitals
Population
Case-Control Studies
Extremities

ASJC Scopus subject areas

  • Dermatology
  • Medicine(all)

Cite this

Chua, S. L., Amerson, E. H., Leslie, K. S., McCalmont, T. H., Leboit, P. E., Martin, J. N., ... Maurer, T. A. (2014). Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era. British Journal of Dermatology, 170(4), 832-839. https://doi.org/10.1111/bjd.12721

Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era. / Chua, S. L.; Amerson, E. H.; Leslie, K. S.; McCalmont, T. H.; Leboit, P. E.; Martin, J. N.; Bangsberg, David; Maurer, T. A.

In: British Journal of Dermatology, Vol. 170, No. 4, 2014, p. 832-839.

Research output: Contribution to journalArticle

Chua, S. L. ; Amerson, E. H. ; Leslie, K. S. ; McCalmont, T. H. ; Leboit, P. E. ; Martin, J. N. ; Bangsberg, David ; Maurer, T. A. / Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era. In: British Journal of Dermatology. 2014 ; Vol. 170, No. 4. pp. 832-839.
@article{a0db90be7bbe4c1888171dab7c67c50a,
title = "Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era",
abstract = "Background Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. Objectives To determine factors associated with PPE in HIV-infected persons receiving ART. Methods A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. Results Twenty-five of 45 cases (56{\%}) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL-1 (96{\%} vs. 85{\%}, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8+ T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). Conclusions Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions. What's already known about this topic? Papular pruritic eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. PPE is characterized by symmetrically distributed itchy papules, worst on the extremities, with similar microscopic findings to insect bites or stings. What does this study add? Persistent or recurrent PPE in antiretroviral therapy (ART)-treated persons is associated with greater HIV RNA load at ART commencement but not during treatment. No association was found with CD4 count, CD4 gains and T-cell activation markers.",
author = "Chua, {S. L.} and Amerson, {E. H.} and Leslie, {K. S.} and McCalmont, {T. H.} and Leboit, {P. E.} and Martin, {J. N.} and David Bangsberg and Maurer, {T. A.}",
year = "2014",
doi = "10.1111/bjd.12721",
language = "English (US)",
volume = "170",
pages = "832--839",
journal = "British Journal of Dermatology",
issn = "0007-0963",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Factors associated with pruritic papular eruption of human immunodeficiency virus infection in the antiretroviral therapy era

AU - Chua, S. L.

AU - Amerson, E. H.

AU - Leslie, K. S.

AU - McCalmont, T. H.

AU - Leboit, P. E.

AU - Martin, J. N.

AU - Bangsberg, David

AU - Maurer, T. A.

PY - 2014

Y1 - 2014

N2 - Background Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. Objectives To determine factors associated with PPE in HIV-infected persons receiving ART. Methods A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. Results Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL-1 (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8+ T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). Conclusions Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions. What's already known about this topic? Papular pruritic eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. PPE is characterized by symmetrically distributed itchy papules, worst on the extremities, with similar microscopic findings to insect bites or stings. What does this study add? Persistent or recurrent PPE in antiretroviral therapy (ART)-treated persons is associated with greater HIV RNA load at ART commencement but not during treatment. No association was found with CD4 count, CD4 gains and T-cell activation markers.

AB - Background Pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. Its aetiology has been attributed to insect bite reactions and it is reported to improve with antiretroviral therapy (ART). Its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. Objectives To determine factors associated with PPE in HIV-infected persons receiving ART. Methods A case-control study nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases had received ART for ≥ 15 months and had an itchy papular rash for at least 1 month with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. Results Twenty-five of 45 cases (56%) had microscopic findings consistent with PPE. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL-1 (96% vs. 85%, P = 0·31). The odds of having PPE increased fourfold with every log increase in viral load at ART initiation (P = 0·02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains and CD8+ T-cell activation measured 6 and 12 months after ART commencement were not associated with PPE. Study participants who reported daily insect bites had greater odds of being cases [odds ratio (OR) 8·3, P < 0·001] or PPE cases (OR 8·6, P = 0·01). Conclusions Pruritic papular eruption in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. Skin biopsies are important to distinguish between PPE and other itchy papular eruptions. What's already known about this topic? Papular pruritic eruption (PPE) of HIV is common in HIV-infected populations living in the tropics. PPE is characterized by symmetrically distributed itchy papules, worst on the extremities, with similar microscopic findings to insect bites or stings. What does this study add? Persistent or recurrent PPE in antiretroviral therapy (ART)-treated persons is associated with greater HIV RNA load at ART commencement but not during treatment. No association was found with CD4 count, CD4 gains and T-cell activation markers.

UR - http://www.scopus.com/inward/record.url?scp=84940220736&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940220736&partnerID=8YFLogxK

U2 - 10.1111/bjd.12721

DO - 10.1111/bjd.12721

M3 - Article

C2 - 24641299

AN - SCOPUS:84940220736

VL - 170

SP - 832

EP - 839

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 0007-0963

IS - 4

ER -