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 *** re-sulting scars ar e disfiguring and *** thesubstantial pr...
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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 *** re-sulting scars ar e disfiguring and *** 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 ***,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,*** occurred in the month preceding May *** 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 *** Outcome Measures:Histolo gical characteristics of new pruritic *** assessm ents included CD4c ell count,eosinophil count,and physic ian-assessed rash ***:Of 109patients meeting inclusion cri-teria,102(93.6%)-completed th e *** 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;Psix patients(84%;95%confidence interval,77%-91%)had biopsy findings characteristic of arthropod *** 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 ***-sions:Pruritic papular eruption oc curring in HIV-infe cted individuals may be a reaction to arth ropod *** 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.
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