摘要
Context:A frequent cause of human im munodeficiency virus(HIV)-related morbidity in sub-Saharan Africa i s a commonly occurring,intensely prur itic skin rash.The re-sulting scars ar e disfiguring and stigmatizing.Despite the substantial prevalence of pruritic p apular eruption(PPE)among HIV-infected Africans,the cause has been elusive. Objective:To determine the etiolog y of PPE occurring in HIV-infected individu als.Design,Setting,and Patients:Cross-sectional study of HIV-infec ted pat ients with active PPE from clinics in Uganda conducted from May 19through June 6,2003.Enrollment occurred in the month preceding May 19.Each partici pant was clinically examined by 2dermatologists,had laboratory stu dies perfor med,was ad-ministered an epidemiologic questionnaire,and had a skin biopsy of a new lesion evaluated by a d ermatopathologist.Main Outcome Measures:Histolo gical characteristics of new pruritic lesions.Other assessm ents included CD4c ell count,eosinophil count,and physic ian-assessed rash severity.Results:Of 109patients meeting inclusion cri-teria,102(93.6%)-completed th e study.The CD4cell counts in this study population were generally low(median ,46/μL)and inversely related to increasing rash severity(median CD4cell counts:122for mild,41for moderate,and 9for severe;P<.001for trend ).Eighty-six patients(84%;95%confidence interval,77%-91%)had biopsy findings characteristic of arthropod bites.Patients with arthropod bite s on biopsy had signifi-cantly higher peripheral eosinophi l counts(median, 330vs180/μL;P=.02)and had a trend toward lower CD4cell counts(me dian,40vs 99/μL;P=.07)than those without histological evidence of a rthropod bites.Conclu-sions:Pruritic papular eruption oc curring in HIV-infe cted individuals may be a reaction to arth ropod bites.We hy-pothesize that th is condition refle cts an altered and exag-gerated immune response to arthropod antigens in a subset of susceptible HIV-infected patien ts.
Context:A frequent cause of human im munodeficiency virus(HIV)-related morbidity in sub-Saharan Africa i s a commonly occurring,intensely prur itic skin rash.The re-sulting scars ar e disfiguring and stigmatizing.Despite the substantial prevalence of pruritic p apular eruption(PPE)among HIV-infected Africans,the cause has been elusive. Objective:To determine the etiolog y of PPE occurring in HIV-infected individu als.Design,Setting,and Patients:Cross-sectional study of HIV-infec ted pat ients with active PPE from clinics in Uganda conducted from May 19through June 6,2003.Enrollment occurred in the month preceding May 19.Each partici pant was clinically examined by 2dermatologists,had laboratory stu dies perfor med,was ad-ministered an epidemiologic questionnaire,and had a skin biopsy of a new lesion evaluated by a d ermatopathologist.Main Outcome Measures:Histolo gical characteristics of new pruritic lesions.Other assessm ents included CD4c ell count,eosinophil count,and physic ian-assessed rash severity.Results:Of 109patients meeting inclusion cri-teria,102(93.6%)-completed th e study.The CD4cell counts in this study population were generally low(median ,46/μL)and inversely related to increasing rash severity(median CD4cell counts:122for mild,41for moderate,and 9for severe;P<.001for trend ).Eighty-six patients(84%;95%confidence interval,77%-91%)had biopsy findings characteristic of arthropod bites.Patients with arthropod bite s on biopsy had signifi-cantly higher peripheral eosinophi l counts(median, 330vs180/μL;P=.02)and had a trend toward lower CD4cell counts(me dian,40vs 99/μL;P=.07)than those without histological evidence of a rthropod bites.Conclu-sions:Pruritic papular eruption oc curring in HIV-infe cted individuals may be a reaction to arth ropod bites.We hy-pothesize that th is condition refle cts an altered and exag-gerated immune response to arthropod antigens in a subset of susceptible HIV-infected patien ts.
