hiv rash

What Is an HIV Skin Rash?

Anti-HIV medications can cause mild skin rashes as well as serious, even life-threatening rashes. The vast majority of HIV skin rashes are mild to moderate. They usually appear within a few weeks of starting a new medication and often go away with continued use of the medication. However, because some rashes can be serious, you should contact your doctor if you notice a skin rash. He or she will advise you on how to best manage the condition.

HIV Medicines That Cause Skin Rashes

A skin rash may occur with medications from any of the three main HIV drug classes:

NNRTIs (non-nucleoside reverse transcriptase inhibitors)
NRTIs (nucleoside reverse transcriptase inhibitors)
PIs (protease inhibitors).

NNRTIs

NNRTIs cause the majority of HIV skin rashes, with Viramune^Ž (nevirapine) causing the most severe rash. If you and your doctor decide to use Viramune as part of your treatment for HIV, you will likely be instructed to take only one pill a day for the first 14 days and then to increase to two pills a day. This dosing schedule may decrease your risk of developing a severe skin rash. Women appear to be at higher risk for developing Viramune-associated skin rashes than men.

NRTIs

NRTIs may also cause skin rashes. Ziagen^Ž (abacavir) may cause a rash that is a symptom of a severe drug hypersensitivity (allergic reaction). If you develop a rash while taking Ziagen, notify your doctor right away. If you and your doctor decide that you need to stop taking the drug, you should never take Ziagen again. Any exposure to it in the future could cause an even more severe reaction.

PIs

Agenerase^Ž (amprenavir) is the PI most likely to cause a skin rash. If you are allergic to sulfa drugs, your doctor should monitor you carefully if you start taking Agenerase as part of your HIV treatment.

Severe HIV Skin Rashes

Severe skin rashes cause significant damage to the skin and can result in serious complications, even death. The severe skin rashes that may occur with the use of anti-HIV medications are known as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These are two different forms of the same kind of skin rash.

TEN differs from SJS in the extent of skin damage, with TEN involving at least 30 percent of the total body skin area. Both SJS and TEN are severe conditions that must be treated by a doctor.

The symptoms of SJS and TEN include:

Flat or raised red spots on the skin that develop blisters in the center
Blisters in the mouth, eyes, genitals, or other moist areas of the body
Peeling skin that results in painful sores
Fever
Headache
A general feeling of illness.

Life-Threatening HIV Skin Rash

Another rare but life-threatening rash occurs as part of the DRESS syndrome (drug rash with eosinophilia and systemic symptoms). DRESS is characterized by a drug-related rash with eosinophilia (an increase in the amount of certain white blood cells in the blood) and whole-body symptoms, such as fever, blood abnormalities, and organ inflammation.

Treatment for HIV Skin Rash

If you have a mild or moderate skin rash, you and your doctor may decide to change the medications you are taking to combat the HIV virus. Or, your doctor may treat you with an antihistamine drug while you continue on the same HIV treatment plan. Be sure to talk with your doctor before stopping or making any changes to your medications.

In cases of severe rash (SJS, TEN, or DRESS), your doctor will stop your anti-HIV medication and may admit you to the hospital. While in the hospital, you may be treated with intravenous (IV) fluids and medications such as anti-inflammatories and antibiotics. Patients with TEN and significant skin loss may need to be in a hospital's burn unit for specialized care.

Future Precautions If an HIV Skin Rash Develops

If you have a severe skin rash while taking anti-HIV medications, you and your doctor must identify which medication likely caused the rash. You should never take that medication again -- even as part of a future HIV treatment program. Exposure to the problem medication could result in an even more severe, and perhaps fatal, drug reaction. Also, if you experienced a reaction to a drug in a particular class (for example, an NNRTI), you may be at risk of a serious reaction to another drug in that class. This is referred to as cross-hypersensitivity.