(RITA!) HIV Treatment Alerts - February 2001
Brad Bowden, MD - a Houston dermatologist who specializes in HIV, tackles patient questions

A: Possibly. HIV-associated Kaposi's sarcoma (KS) has a misleading name. Sarcoma implies "cancer," but it is now clear that KS is just one of the many opportunistic infections seen in HIV disease. KS is thought to be caused by human herpesvirus-8 (HHV-8). Other herpes family viruses include herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV). Since KS is a systemic viral infection, it causes "vascular" lesions throughout the body. Patients usually request treatment for KS because of the characteristic discolored areas of the skin, mouth and eyes (usually ranging from pink to red or purple to brown or black).

It's remarkable how the incidence of KS has decreased as the combination anti-HIV medications have been introduced. In fact, I estimate that I see less than 5% of the cases I was seeing 3 to 4 years ago. I attribute this to patients' immune systems improving with lower viral load levels and higher T cell counts. However, to date there exists no medication effective against the virus that causes KS. In fact, because of its historical classification as a cancer, treatment of KS has been a responsibility of oncologists.

The most important thing to do is treat the HIV to allow the body's immune system to control the KS virus. If this fails, physicians and dentists might use a variety of topical and systemic treatments. Retinoid gels, cryotherapy (freezing the lesions with liquid nitrogen), interferon, vinblastine, daunorubicin, or doxorubicin are some options that your doctor or dentist may consider. He or she can explain the pros and cons of these with you if you have KS.

Q: What are these itchy bumps I get on my skin?

A: One of the most common causes of this complaint is an inflammation of the hair follicles called "eosinophilic folliculitis" (EF). This is a very uncomfortable, itchy condition that comes and goes. I am seeing just as much EF in my patients whose immune systems have improved with "cocktail" therapy as I was beforehand. Patients usually complain of small, red, bite-like bumps or pustules on the face, neck, and upper torso. Any part of the body, except the palms and soles where hair follicles don't exist, can be affected. Sweating usually makes EF worse and sunlight usually helps to relieve the itch.

The cause of EF is unknown. Since HIV causes abnormal immune function, not just immune suppression, many skin conditions I see are related to an exaggerated reaction of the immune system. One theory is that EF is an example of an immune overreaction to a yeast that lives on everyone's skin.

Initial treatments include small amounts of ultraviolet light (natural or otherwise) with topical or oral anti-itch agents. If this doesn't help, an oral antifungal itraconazole (Sporanox) is often helpful. If this fails, oral isotretinoin (Accutane) is almost always effective. However, both oral agents can have side effects and their use must be approved by your physician.

Q: What can I do about warts?

A: There are 2 types of warts that I commonly see: molluscum contagiosum and verruca vulgaris (common warts). I still see both types of viral warts, although less than before. Molluscum causes smooth bumps on the body with the beard and face being the most common site. Verruca are caused by the human papillomavirus (HPV), the same virus that causes condyloma acuminatum (genital warts). They appear as rough or pink spots anywhere on the body.

I always tell my patients that the ultimate cure of either of these viral conditions is up to their immune systems. All treatments can help reduce the number or appearance of the warts, but no treatment guarantees a cure. Most methods are destructive (freezing, burning, cutting, or chemical). However, two new topical medications are now available: imiquimod (Aldara cream) and polofilox (Condylox gel). Aldara works with the patient's immune system to boost the immune response where it is applied. Condylox is applied to the warts to kill the cells that contain the virus, causing them to peel off.

Plantar warts are called such because the sole of the foot is called the plantar surface. Due to the thickness of the skin in this area, they present the greatest treatment challenge. Intralesional bleomycin can be used to penetrate and kill the HPV-containing skin cells, causing the wart to turn black and peel off.

Brad Bowden, MD, is an instructor in the Department of Internal Medicine, Baylor College of Medicine, and the Department of Dermatology, University of Texas Medical School at Houston. He is also an attending dermatologist at Thomas Street Clinic and at the Audette (Montrose) Clinic in Houston. Send your questions for physicians to rita@centerforaids.org or by mail: Questions, P.O. Box 66306, Houston TX 77266-6306.

DEFINITIONS

Oncologists: doctors trained in the treatment of cancer.

Systemic: affecting the body in general.

Topical: involving the local application to a body part, usually on the skin.

20010210
RI010207

Copyright © 2001 - Research Initiative Treatment Action (RITA!). Reproduced with permission. RITA! is published by The Center for AIDS. Contact Thomas Gegeny, MS, ELS, Editor, RITA! for permission to reproduce RITA!. tom@centerforaids.org. http://www.centerforaids.org

ÆGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

ÆGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1985, 2001. ÆGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on ÆGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS and the Sisters of Saint. Elizabeth of Hungary, or the party credited as the provider of the content.