Immune reconstitution inflammatory syndrome involving the skin

Immune reconstitution inflammatory syndrome (IRIS) occurs in 10-25% of unselected patients starting highly active antiretroviral therapy (HAART). About 52-78% of these cases involve cutaneous features.

To describe the prevalence and incidence of new dermatological conditions within 6 months of patients starting HAART, and to specify the clinical and immunological features and time of onset in patients responding to HAART.

A retrospective cohort analysis was performed of 59 treatment-naive patients started on HAART and followed up for 6 months by a clinician trained in dermatology. Medical records were reviewed for new dermatological conditions diagnosed clinically.

In all, 30 patients (50.8%) developed 45 new skin conditions at a median of 8 weeks (range 3-24 weeks) after starting HAART. The incidence rate was 104.5 cases per 100 patient-years. Diagnoses included seborrhoeic dermatitis (nine patients), anogenital herpes (seven patients), acne, tinea and folliculitis (six patients each), Kaposi's sarcoma, herpes zoster, genital warts and eczema (two patients each), and molluscum contagiosum, planar warts and pityriasis versicolor (one patient each). Significantly more women (23/38; 60.5%) than men (7/21; 33.3%) (P < 0.05) developed new skin lesions after starting HAART. Baseline median CD4 counts in those with and without IRIS were 60/microL and 62/microL, respectively, and in both groups, the counts increased to > 90/microL by week 12. Baseline median viral load was > 100,000 copies/mL and was < or = 32 copies/mL by week 12. In both groups, the majority of patients were in World Health Organization stages 3 and 4.

New skin lesions were very common in this cohort, with the majority being women and patients with very low baseline CD4 counts.