Skin infections in HIV patients

Treating cutaneous infections requires that the provider be aware of the spectrum of challenges that may be faced in an immunosuppressed patient. An unusual infection or even a common infection that is recalcitrant to treatment may be a clue that can suggest a diagnosis of immunosuppression or HIV infection. In a patient who has already been diagnosed, it becomes important to realize that immunosuppression can modify the course of common diseases. Unusual presentations, resistance to traditional treatments, increased risks of a more aggressive course, disease progression, and complications are all common challenges in this population subset. Although the epidemiologic incidence of opportunistic infections has decreased with the onset of highly active antiretroviral therapy (HAART), the clinician still must be familiar with the presentation of infections that occur more frequently in immunosuppressed patients as well as the possibility of other unusual infections that need to be considered in the differential diagnosis of a cutaneous infection for HIV positive patients. Certain dormant infections, such as mycobacterial disease or varicella zoster, may flare up following the initiation of HAART in what is known as the immune reconstitution inflammatory syndrome (IRIS). The detection of opportunistic infections also provides a clue to the degree of immunosuppression since certain infections are associated with decreased CD4 levels. Several cutaneous infections can also be AIDS defining. Worldwide, and in the individual patient with advanced immunosuppression, these infections can result in significant morbidity and even death. It is the purpose of this chapter to survey the more common cutaneous infections seen in patients with HIV infection.