CUTANEOUS DISEASE AND DRUG-REACTIONS IN HIV-INFECTION
CUTANEOUS DISEASE AND DRUG-REACTIONS IN HIV-INFECTION
复制标题
DOI：
10.1056/nejm199306103282304
复制
发表时间：
1993-06-10
影响因子：
158.5
通讯作者：
STERN, RS
中科院分区：
文献类型：
--
作者：
COOPMAN, SA;JOHNSON, RA;STERN, RS
背景。包括药物不良反应在内的皮肤病，被认为在人类免疫缺陷病毒（HIV）感染和获得性免疫缺陷综合征（艾滋病，AIDS）患者中比在其他人中更为常见。这些皮肤疾病可能导致残疾或毁容，并且可能需要停用关键药物。
方法。我们在一个拥有26.5万名成员的健康维护组织中确定了684名HIV感染成员，并查阅了他们的病历，以确定1988年4月1日至1991年1月15日期间皮肤病诊断的频率。我们比较了20至49岁的HIV感染男性和未感染HIV的男性每年因皮肤疾病就诊的比率。我们使用一个自动化的处方数据库来量化药物暴露情况。
结果。在684名HIV感染患者中，540名（79%）被给予了一种或多种皮肤病诊断，总共2281次诊断，包括188次药物皮肤反应。有43次因蜂窝织炎（n = 15）、皮肤药物反应（n = 13）或其他皮肤问题住院。与未感染HIV的男性相比，艾滋病男性在20种最常见的感染性和炎症性皮肤疾病中的18种就诊率至少高5倍，在9种疾病中至少高15倍。皮肤反应发生率最高（每1000个疗程）的药物包括复方磺胺甲恶唑（149）、磺胺嘧啶（200）、氨苯砜 - 甲氧苄啶（156）和氨基青霉素类（93）。皮肤病诊断的数量根据疾病阶段而增加：在刚确诊HIV感染之前的患者中最低，在被诊断为艾滋病的患者中最高。
结论。包括药物反应在内的皮肤病在HIV感染患者中极为常见，并且其发病率随着免疫功能的恶化而增加。
Background. Skin diseases, including adverse reactions to drugs, are thought to be more common among patients with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) than among other persons. These skin conditions can be disabling or disfiguring and may require discontinuation of essential drugs.Methods. We identified 684 HIV-infected members of a 265,000-member health maintenance organization and reviewed their medical records to determine the frequency of dermatologic diagnoses from April 1, 1988, through January 15, 1991. We compared the rates of visits per year for skin conditions by HIV-infected men, 20 to 49 years of age, with those by non-HIV-infected men. We used an automated prescription data base to quantify exposures to drugs.Results. Of the 684 HIV-infected patients, 540 (79 percent) were given one or more dermatologic diagnoses, for a total of 2281 diagnoses, including 188 cutaneous reactions to drugs. There were 43 hospitalizations for cellulitis (n = 15), cutaneous drug reactions (n = 13), or other skin problems. As compared with non-HIV-infected men, the men with AIDS had visit rates that were at least 5 times higher for 18 of the 20 most common infectious and inflammatory skin conditions and at least 15 times higher for 9 conditions. Drugs with the highest rate of cutaneous reactions (per 1000 courses) included trimethoprim-sulfamethoxazole (149), sulfadiazine (200), trimethoprim-dapsone (156), and aminopenicillins (93). The number of diagnoses of skin conditions increased according to the stage of disease: it was lowest in patients immediately before the documentation of HIV infection and highest in patients with a diagnosis of AIDS.Conclusions. Cutaneous diseases, including drug reactions, are extremely common in patients with HIV infection, and their incidence increases as immune function deteriorates.