Conditions in Patients With CD4+ Cell Counts Below 200/μL Who Are Not on Antiretroviral Therapy

With the institution of antiretroviral therapy, psoriasis can be controlled with topical treatments, such as clobetasol and calcipotriene and ultraviolet light. Before adequate immune reconstitution under antiretroviral therapy occurs or in cases of complex or more severe psoriasis, treatment with the retinoid agent acitretin at 10 to 25 mg/d can be considered; it should be noted that this agent is associated with increases in triglycerides and cholesterol. Psoriasis in HIV disease can have unusual presentations. Figure 1 shows inverse psoriasis of the feet and underarm, differing from the common presentation of psoriasis on extensor surfaces.