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Porphyrin Abnormalities in Acquired Immunodeficiency Syndrome
William J. O'Connor, MB, MRCPI;
Gillian M. Murphy, MD, FRCPI;
Cyndi Darby, MSc;
Jane Fogarty, MSc;
Fiona Mulcahy, MB, FRCPI;
Rory O'Moore, MD, FRCPI;
Louise Barnes, MB, FRCPI
Arch Dermatol. 1996;132(12):1443-1447.
Abstract
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Objective
To examine prospectively porphyrin metabolism in a human immunodeficiency virus (HIV) -positive population.
Setting
Specialist referral unit at the Department of Genitourinary Medicine, St James's Hospital, Dublin, Ireland.
Patients
Twenty-eight men and 5 women (age range, 18-35 years). Twenty-nine were current or previous intravenous drug abusers. Four were thought to have sexually acquired HIV infection. All had a history of acquired immunodeficiency syndrome—defining illnesses. The patients were selected as a consecutive sample from the inpatient department. Eligibility criteria were cooperation with urine and stool collection and confirmed HIV seropositivity. The patients were matched to 2 groups: 1 with normal results of porphyrin studies and the other with abnormal findings from porphyrin studies.
Intervention
None.
Main Outcome Measures
Plasma, urine, and stool porphyrin excretion patterns.
Results
Of the 33 patients in the study, 13 (40%) had increased urinary porphyrin excretion. All but 2 of these patients were seropositive for hepatitis C virus. No study patient had clinical evidence of porphyria. Four patients (12%), however, had urine and stool porphyrin excretion patterns that were classic for porphyria cutanea tarda. All 4 of these patients were hepatitis C virus— positive. Patients with porphyrinuria had a greater degree of immunosuppression (P=.002) than those with normal porphyrin metabolism, and they were more likely to be taking zidovudine (P=.009).
Conclusions
Commonly, porphyrin metabolism is abnormal in persons with established HIV infection. Hepatitis C may contribute to abnormal porphyrin metabolism. An unexpected number of patients studied had porphyrin excretion patterns that were characteristic of porphyria cutanea tarda, and all of these were hepatitis C virus—positive. A diagnosis of porphyria cutanea tarda, especially in a young patient, should prompt investigation for underlying HIV and hepatitis C virus infections. Dermatologists should be aware of the infectious risk associated with the vesicles and erosions in these patients. Porphyrin studies should be performed in any patient with HIV and photosensitivity.
Arch Dermatol. 1996;132:1443-1447
Author Affiliations
From the Departments of Dermatology (Drs O'Connor and Barnes), Biochemistry (Mss Darby and Fogarty and Dr O'Moore), and Genitourinary Medicine (Dr Mulcahy), St James's Hospital, and the Department of Dermatology, Beaumont Hospital (Dr Murphy), Dublin, Ireland. Dr O'Connor is now with the Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minn.
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