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Fever and rash in HIV-infected patients

Fred A Lopez, MD
Charles V Sanders, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Howard Libman, MD, FACP


Before the introduction of effective combination antiretroviral therapy, dermatologic manifestations affected up to 80 to 90 percent of individuals infected with the human immunodeficiency virus (HIV) [1-4]. The frequency of cutaneous manifestations was illustrated in a review of 684 HIV-infected patients who were followed for almost three years; 540 patients (79 percent) were given one or more (average 3.7) dermatologic diagnoses [3,5]. Importantly, a higher number of mucocutaneous diseases in HIV-infected patients has been shown to correlate with poor prognosis and a shorter time to the development of AIDS [6,7].

Rash can occur as a manifestation of HIV infection, another infection, some neoplasms, and frequently as a reaction to a drug. The defect in cell-mediated immunity that results from HIV infection predisposes infected individuals to certain bacterial, fungal, mycobacterial, and viral infections, many of which have skin manifestations. In addition, many immune reconstitution inflammatory syndrome-associated events are dermatological and warrant consideration in the HIV-infected individual who has recently started highly active antiretroviral therapy [8,9].

Characteristic fever and rash syndromes in the HIV-infected patient will be reviewed here. Recognition of these syndromes may allow for earlier detection of HIV infection and the salutary effects of initiating antiretroviral therapy.

The diagnosis and treatment of the individual diseases as well as the epidemiology, etiology, and diagnostic approach to fever and rash in HIV-uninfected immunocompromised hosts and in normal hosts are discussed separately. (See "Fever and rash in immunocompromised patients without HIV infection" and "Fever and rash in the immunocompetent patient".)


Patients with HIV infection have an increased incidence of bacterial infections that is related to both deficiencies in T cell function and dysregulation of humoral immunity in advanced disease.

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