Etretinate and AIDS-related Reiter's disease

HIV infection and rheumatic diseases: the changing spectrum of clinical enigma

In this article, the authors discuss the occurrence and prevalence of rheumatic syndromes before and after highly active antiretroviral therapy became the usual mode of treatment. The immunologic, environmental, and genetic factors behind the combination of HIV infection and rheumatic manifestation contribute to the complexity of these diseases. Miscellaneous case reports are discussed in relation to HIV infection. The authors conclude that geriatric care of HIV patients is on the horizon as more people have access to newer, more effective therapy and mortality is on the decline. Younger HIV patients will be committed to a lifetime of therapy to address bone disease and other chronic problems. In the future, newer agents may steer the clinical scenario in unforeseen directions.

Reiter's syndrome: the classic triad and more

Reiter's syndrome, also known as reactive arthritis, is the classic triad of conjunctivitis, urethritis, and arthritis occurring after an infection, particularly those in the urogenital or gastrointestinal tract. Dermatologic manifestations are common, including keratoderma blennorrhagicum, circinate balanitis, ulcerative vulvitis, nail changes, and oral lesions. Epidemiologically, the disease is more common in men, although cases have also been reported in children and women. The pathophysiology has yet to be elucidated, although infectious and immune factors are likely involved. Clinical presentation, severity, and prognosis vary widely. Treatment is difficult, especially in HIV-positive patients. Prognosis is variable; 15% to 20% of patients may develop severe chronic sequelae.

HIV-related psoriasis and Reiter's syndrome

Infection with the human immunodeficiency virus (HIV) is associated with the development of psoriasis and related disorders, including psoriatic arthritis, dactylitis and enthesitis, and Reiter's syndrome. The etiologic mechanisms remain unclear but most likely represent a combination of genetic and environmental factors. Therapy for these diseases in the setting of HIV infection is often difficult not only because of their characteristically increased severity, but also because the use of conventionally effective immunosuppressive agents may be counterproductive in this patient population.

The use of calcipotriol in HIV-related psoriasis

We report the case of a 28-year-old homosexual man with advanced HIV disease (CDC classification group IV A) who developed erythrodermic psoriasis which responded to calcipotriol, a topical vitamin D analogue. We believe this to be the first reported case of HIV-related psoriasis responsive to this form of treatment. Systemic therapy for HIV-related psoriasis is limited because of immunosuppressive effects. We suggest that calcipotriol may prove to be a useful therapeutic option in these patients.