Cutaneous manifestations of highly active antiretroviral therapy

The introduction of combination antiretroviral drug therapy in the mid 1990s resulted in a dramatic decrease in morbidity and mortality among patients infected with human the immunodeficiency virus (HIV).1 These drug combinations, referred to as highly active antiretroviral therapy (HAART), have been shown to reduce viral replication significantly and reconstitute CD4+ lymphocyte counts in HIVpositive patients.2 The drugs that comprise HAART regimens are categorized by their distinct mechanisms of action into four main groups: Non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), and fusion or entry inhibitors. Since their implementation, the overall utility of these medications has been complicated by an increasing number of adverse drug reactions that have become recognized. Documented cutaneous side-effects such as pigmentation disorders, urticarial eruptions, and hypersensitivity reactions have all been associated with HAART therapy. In addition, a common adverse effect is a syndrome of hyperlipidemia, abnormal fat distribution, and glucose intolerance known as the lipodystrophy syndrome.3 Such sideeffects have substantially diminished compliance with antiretroviral medications and pose a problem for their continued use.4.