Therapy update on HIV and skin disease

Skin disease is highly prevalent in patients with HIV and causes significant morbidity through severe symptoms, as well as stigmatising, disfiguring lesions. It is associated with mortality, either as a manifestation of generalised conditions or, less commonly, due to a primary cutaneous disorder. Early treatment of HIV infection provides near normal life expectancy; however, currently an estimated 24% of HIV-infected people are undiagnosed in the UK, with 47% presenting as a late diagnosis (CD4+ cell count <350 mm3). The integumentary system provides a window to immune function, enabling detection of derangement, therefore facilitating earlier diagnosis. Although some HIV-associated skin diseases may present pathognomonically, many do not. Thus, clinicians must adopt a low threshold of suspicion of HIV, particularly in conditions that are atypical, severe, occur in combination or are recalcitrant to treatment. Antiretroviral treatment has improved life expectancy and reduced opportunistic infections while newer medications have improved side effect profiles; however, adverse drug reactions are common and awareness of drug interactions is vital. This review aims to provide a brief overview of HIV-associated skin disease with a focus on cutaneous infections, inflammatory diseases and adverse drug reactions.