HIV medicine for dermatologists and venereologists

Abstract

Broad administration of combined antiretroviral therapy (ART) has dramatically reduced the morbidity and mortality of the HIV-infection and substantially improved the life expectancy of people living with HIV (PLWH). PLWH, who are effectively treated with an ART, are considered to be unable to transmit HIV. The standard of care is usually an antiretroviral single tablet regimen. Since 2015 the Robert Koch Institute has reported a slight decrease in the rate of recently diagnosed HIV-infections in Germany, but the proportion of late presenters (initial diagnosis in advanced stages of infection) has remained consistently high at around 32 % since 2005. HIV-infections have not been diagnosed in 10,800 PLWH so far. In comparison to the general population PLWH suffer more frequently from skin diseases. Depending on the stage of immunodeficiency, untreated PLWH develop HIV indicator diseases of the skin and the mucocutaneous membranes. Knowledge of these diseases facilitates the selection of individuals who should be offered HIV testing. Early diagnosis of HIV-infections allows early introduction of the ART, prevents the spread of HIV and reduces the mortality rates and treatment costs associated with late diagnosis. HIV is a predominantly sexually transmitted infection. Through focused sexual anamnesis and the diagnosis of HIV indicator diseases and other sexually transmitted infections, dermatovenereologists in particular may be able to identify previously undiagnosed PLWH and persons with an increased risk of HIV infection, enabling initiation of ART in the former and pre-exposure prophylaxis counseling in the latter.