結論（CONCLUSIONS）
HIV 疾病表現的數量與多樣性，在皮膚上多於任何其他器官。皮膚併發症是顯著疾病負擔的來源，也可能造成污名化。雖然 ART 已降低數種 HIV 相關皮膚病症的發生率，其他疾患如 IRIS、藥物反應、代謝紊亂、HPV 感染與 SCCs 仍常被觀察到。事實上，由於 HIV 感染者存活期延長，它們的發生率甚至可能正在增加。藉由辨識 HIV 相關皮膚病症的光譜並執行適當的診斷檢查，即可及時給予治療並使結果最佳化。
我們的電子書中提供額外的圖片（存取碼請見封面內頁）。
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在 HIV 感染者中，trimethoprim–sulfamethoxazole（TMP-SMX）是皮膚藥物反應最常見的原因。TMP-SMX 常用於 Pneumocystis jirovecii 肺炎或弓形蟲病的預防或治療，靜脈給藥時在 50%–60% 的病人中導致發疹性疹與發燒（典型於開始治療後 8–12 天）（圖 78.20）。此發生率為一般族群所觀察到的 10 倍。TMP-SMX 的其他副作用包括固定性藥物疹、SJS 與 TEN。
密切觀察往往已足夠，因為大多數皮膚藥物疹會自發消退，尤其是麻疹樣型。然而，若發生發燒等全身徵象或觀察到表皮剝離，應立即停用可疑的致病藥物，因為這可能預示更嚴重、甚至危及生命的併發症。對於某些藥物如 zidovudine、磺胺類與 dapsone，病人在發生藥物不良反應後可能成功減敏。藥物再挑戰應在受控制的情況下進行。Abacavir 禁止再挑戰，且 NNRTIs 不建議再挑戰。
圖 78-20：由 trimethoprim–sulfamethoxazole（TMP-SMX）所致的麻疹樣藥物疹。這名 HIV 年輕男性在開始使用 TMP-SMX 後 8 天，發生廣泛的可壓退性紅斑斑與丘疹疹。注意上軀幹的融合。
Fig. 78.20 Morbilliform drug eruption due to trimethoprim–sulfamethox- azole (TMP-SMX). This young man with HIV developed a widespread eruption of blanchable erythematous macules and papules 8 days after starting TMP-SMX. Note the coalescence on the upper trunk.