Initiation of antiretroviral therapy in HIV-infected adults with skin complaints in northern Tanzania

Abnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)-infected persons globally. A prospective cohort study of HIV-infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV-infected subjects presenting with skin complaints who met criteria for ART initiation were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed and CD4(+) cell counts and plasma HIV RNA levels were measured. All subjects received a fixed-dose combination of stavudine lamivudine and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow-up. Median baseline CD4(+) cell counts and plasma HIV RNA levels were 120 cells/mul and 5.2 log10 copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3 which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months the median CD4(+) cell count had increased to 474 cells/mul and plasma HIV RNA levels were