It is an axiom that all HIV-infected individuals will develop skin diseases at some time during their infection. Moreover, as the life spans of these individuals increase, it is likely that they will develop even more skin diseases. Although similar to those seen in the non-HIV infected population, many of these more chronic, severe, and treatment- resistant, frequently necessitating innovative interventions, existing knowledge about efficacy is anecdotal at best.
The specific aims of this giant application: (1) to compare innovative and conventional treatments in the management of common HIV/AIDS-related skin diseases with respect to efficacy, safety, impact on quality of- life, and cost, utilizing quantifiable (objective and subjective) outcome measurements and statistical analyses; (2) to assess the effects of chronic application of the allergen, DNCB, on the clinical course of HIV infection; and (3) to take advantage of the clinical, dermatological, and immunological follow-up of study patients (in the first two aims) in order to gain pathogenic insights into the interrelationship among HIV infection, skin diseases, and therapeutic interventions. A two-tier group of randomized clinical studies will be conducted at a single site, the Dermatology Clinic at the University of Texas Southwestern Medical Center Aston Ambulatory Care Center, over a period of three years. Subjects will be enrolled during the first two years and followed-up for the remainder of the grant's duration. In the first tier, comparative evaluations will be made concerning treatment alternatives in HIV(+) patients with: scabies - oral ivermectin vs. topical lindane lotion vs. topical permethrin cream; - molluscum - medium-depth chemical peel vs. cryotherapy; eosinophilic folliculitis - oral - metronidazole vs. oral ivermectin vs. oral itraconazole; seborrheic dermatitis desonide cream vs. ketoconazole cream vs. combination therapy; psoriasis - topical calcipotriene vs. oral acitretin vs. UVB irradiation. In the second tier, asymptomatic HIV(+) volunteers plus the subjects in the first tier (with the exception of those with psoriasis) will be subjected to a controlled study of the effects of topical application of chronic DNCB (vs. the non allergen SLS) on the clinical course of HIV infection, including the onset, frequency, severity, and response to treatment of skin diseases. Finally, we will analyze the information derived from these studies with the goal of identifying or developing surrogate biologic markers that might predict predisposition to specific skin diseases, prognosticate responses to therapy, and/or illuminate pathogenesis.
