Maculo-papular rash induced by lopinavir/ritonavir

Area of Science:

• Dermatology
• Infectious Diseases
• Pharmacology

Background:

• Human Immunodeficiency Virus (HIV) disease management often involves combination antiretroviral therapy.
• Protease inhibitors (PIs) are a key component of highly active antiretroviral therapy (HAART).
• Drug-induced dermatoses are a common concern in HIV-positive individuals, potentially impacting treatment adherence.

Observation:

• Two patients with HIV disease presented with pruritic, maculo-papular rashes.
• The onset of the rash occurred 7 and 10 days after initiating lopinavir/ritonavir (Kaletra).
• Dermatitis improved upon drug withdrawal and recurred upon reintroduction, suggesting a causal link.

Findings:

• Histopathologic examination revealed non-specific inflammatory infiltration with neutrophils and lymphocytes.
• Absence of eosinophils and papillary dermal capillary dilatation was noted.
• The rash, though symptomatic, was not life-threatening, allowing for continued treatment without drug suspension.

Implications:

• This case series highlights a potential cutaneous side effect of the protease inhibitor combination lopinavir/ritonavir.
• Understanding and managing drug-related rashes is crucial for maintaining patient compliance in HIV treatment.
• Further research is needed to fully elucidate the safety profile and cutaneous side effects of Kaletra.