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Before and After the Introduction of Antiretroviral Therapy

Priya M. Rajendran, BS; Jacqueline C. Dolev, MD; Michael R. Heaphy, Jr, MD; Toby Maurer, MD

Arch Dermatol. 2005;141:1227-1231.

Objective  To characterize the relationship of new eosinophilic folliculitis (EF) cases between June 30, 1994, and January 5, 2000, and antiretroviral therapy (ART) status and immune reconstitution.

Design  Retrospective cohort analysis.

Setting  Dermatology clinics at a county hospital.

Subjects  Fifty-seven consecutive subjects with biopsy-proved EF from the pathology database. Subject groups were as follows: naïve to ART, receiving ART without protease inhibitors/nonnucleoside reverse transcriptase inhibitors, and receiving ART containing protease inhibitors/nonnucleoside reverse transcriptase inhibitors.

Main Outcome Measures  Onset of EF, CD4 cell count and nadir at EF onset, and time of ART initiation.

Results  Among the 3 groups previously described, mean CD4 cell counts (86.26/µL vs 113.82/µL vs 145.65/µL, respectively [Kruskal-Wallis rank sum test, P = .15]) and nadir (68.43/µL vs 66.18/µL vs 64.17/µL, respectively [Kruskal-Wallis rank sum test, P = .41]) at EF diagnosis were not statistically different. Fifty-two subjects (91%), regardless of treatment group, had a nadir below 200/µL. Of the subjects undergoing ART, 28 (82%) developed EF within 6 months of initiating ART; their average CD4 cell count increase was 108/µL. Of the 23 subjects receiving protease inhibitor/nonnucleoside reverse transcriptase inhibitor–containing ART regimens, 17 (74%) were diagnosed as having EF within 3 months, with 4 additional subjects diagnosed as having EF within 6 months (a total of 21 [91%] of the 23 subjects). This is not significantly different from the 7 (64%) of 11 subjects diagnosed as having EF at 3 and 6 months of starting ART without protease inhibitors/nonnucleoside reverse transcriptase inhibitors (P = .07) (odds ratio, 0.18; 95% confidence interval, 0.01-1.54).

Conclusions  Our study shows an association between low nadir (66.28/µL) and low CD4 cell count (115.54/µL) and the development of EF, regardless of subjects’ ART status. However, most subjects receiving ART were diagnosed as having EF within 3 to 6 months of ART initiation, regardless of the regimen.

Author Affiliations: School of Medicine (Ms Rajendran) and Departments of Dermatology (Drs Dolev and Maurer) and Pathology (Dr Heaphy), University of California, San Francisco.

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