International Journal of STD & AIDS > Volume 19, Number 5 > Pp. 357-358

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Case reports

Undetectable HIV-1 viral load in the fluid of bullous skin lesion in a patient receiving highly active antiretroviral therapy

Pierre Tattevin MD ^* , Anne Maillard MD , Olivier Tribut PharmD , Emilie Saïkali MD ^*, Cedric Arvieux MD ^* and Christian Michelet MD PhD ^*

^* Department of Infectious Diseases; Department of Virology; Department of Pharmacology, Pontchaillou University Hospital, Rennes, France

Correspondence to: Dr Pierre Tattevin Email: pierre.tattevin{at}chu-rennes.fr

Health-care workers may be exposed to bullous fluid while caring for bullous skin diseases in HIV-infected patients. Given that bullous fluid is a filtrate of plasma, it may be assumed that HIV viral load (VL) in bullous fluid is close to plasma VL. This was documented in a patient who had discontinued antiretroviral therapy because of nevirapine-associated toxic epidermal necrolysis, but no data are available in patients receiving antiretrovirals. An HIV-infected woman was admitted for leg cellulitis with a large bullous lesion. Her plasma HIV RNA had been undetectable for two years under the combination of efavirenz and boosted lopinavir. Bullous fluid analysis revealed undetectable HIV-1 RNA, while efavirenz and lopinavir concentrations were 1.4 and 3.4 µg/mL, respectively. The ratio of bullous fluid/plasma concentrations was 0.74 for efavirenz and 0.26 for lopinavir. These data may help us evaluate the need for antiretroviral prophylaxis after occupational exposure to bullous lesions fluid.

Key Words: HIV RNA • bullous skin lesions • lopinavir • efavirenz • occupational exposure

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