Exploring the association between erythema multiforme and HIV infection: some mechanisms and implications.

Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.

The diagnostic accuracy of the HIV 1/2/subtype O Tri-line rapid test compared with ELISA: A pilot study.

BACKGROUND: Accurate HIV diagnosis is essential for appropriate patient care. Rapid tests (RTs) are considered key to HIV screening and management. Some studies have found RTs to be comparable with the ELISA test whilst others have reported lower sensitivity. AIM AND STUDY DESIGN: The aim of this retrospective, descriptive study was to evaluate the sensitivity and specificity of the HIV 1/2/O Tri-line rapid test (HIV-TRT) device compared with ELISA. METHOD: The study sample comprised 45 records of patients who tested for HIV using the HIV-TRT device and ELISA. RESULTS: As compared with ELISA as the 100% gold standard, the sensitivity of the HIV-TRT was 80% (CI: 59%-93%) and specificity was 100% (CI: 83%-100%). ROC area of 0.9 at 95% CI was determined. CONCLUSION: The low sensitivity of HIV-TRT is a concern, since HIV screening in South Africa makes use of RTs.