HIV Management Guide for Clinical Care and ARV Guidelines

HIV Management Guide for Clinical Care and ARV Guidelines

HIV-infectious Disease & Cancer

Clinical presentation

Classic, Type I PRP is characterised by orange-red plaques with fine scale, which develops over weeks-to-months in a rostrocaudal fashion. Typical features which may differentiate it from psoriasis include keratotic follicular papules and ‘islands of sparing’, referring to areas of uninvolved normal skin interspersed between otherwise generalised plaques. (130) Erythroderma (with >90% body surface area …

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Diagnosis

Diagnosis of PRP, including the HIV-associated Type VI subtype, relies on clinical findings and skin biopsy histopathological correlation. Up to 60% of PRP cases in retrospective studies were initially misdiagnosed as other inflammatory skin disorders, most commonly psoriasis, highlighting the diagnostic challenge in this disorder. (132)

Management

Among patients with PRP in the setting of newly diagnosed HIV infection, commencement of ART alone has been reported to induce cutaneous remission. (133, 134) Due to its rarity, management guidelines are based on retrospective studies and case series, and may include topical steroids, retinoids and vitamin D analogs in cases with limited cutaneous involvement, …

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Mpox

Mpox, previously termed monkeypox, is an orthopoxvirus infection predominantely spread through sexual contact. In 2022 a global outbreak led to its declaration as a Public Health Emergency of International Concern by the WHO, with over 78,000 cases across 100 countries. (76) This outbreak disproportionately affected PLWHIV, who comprised approximately 40% of diagnosed cases. (77) To …

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Diagnosis

The diagnosis of mpox requires confirmation by nucleic acid amplification testing (NAAT) using a sterile dry swab collected from lesional fluid or crust. Skin biopsy for NAAT and histopathological analysis can be helpful in patients without vesicles or crusts available to swab. (83) 

Management and Prevention

Treatment of mpox is primarily supportive, with most cases resolving after three weeks. (76) Paraenteral nutrition and hydration may be required in patients unable to tolerate oral intake due to mucosal lesions. Antiviral treatments should be prescribed under the guidance of Infectious Diseases specialists, and may be required in severe cases or in patients with …

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Cytomegalovirus and Epstein-Bar Virus

Other herpesviridiae including cytomegalovirus (CMV) and Epstein-Bar virus (EBV) do not typically present with chronic mucocutaneous lesions. In PLWHIV, mucocutaneous CMV infection is regarded as an AIDS-defining condition. (15)    Clinical Presentation  In PLWHIV and CD4+ count below 200 cells/μL, both CMV and EBV infection may result in chronic mucosal or perianal ulceration, correlating with the …

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Diagnosis

In cases of chronic mucocutaneous ulceration suspected to be secondary to CMV or EBV infection, biopsy for histopathological assessment is necessary to make the diagnosis.  

Management

Improvement of mucocutaneous lesions of CMV and EBV following commencement of ART have been reported in the setting of advanced HIV infection. (48) Systemic antiviral therapy is indicated for CMV infection in immunocompromised patients, and may involve oral valganciclovir or intravenous ganciclovir for up to six weeks. Oral valganciclovir may be continued as secondary prophylaxis …

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Dermatological Conditions

James Pham1,2, Deshan Sebaratnam1,2  Faculty of Medicine and Health, University of New South Wales  Department of Dermatology, Liverpool Hospital  Last reviewed: Jan 2024  Next review due: March 2029  Acknowledgement: We would like to acknowledge Alexis Lara Rivero, Mark Kelly, Cassy Workman & Margot Whitfeld as the original authors of this section and David Wong for …

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