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UVB and PUVA therapies in HIV patients: are they safe?

There are no simple answers to the question posed in the title of this paper. UV is known to induce the HIV genome, suppress the immune system, and modify cytokine patterns in the exposed tissue. UV-inducible cytokines, in turn, may activate HIV or modify the immune response. Thus, it is likely that UV exposure may affect HIV disease. However, the effects may depend on a number of variables, such as the stage of HIV disease, the different skin conditions treated, the changes in skin topography due to skin disease or UV exposure, and differences in UV modalities (UVB, PUVA, combination and other UV therapies). Laboratory studies showed that UVB and PUVA activate HIV or HIV promoter in vitro and in transgenic animals (1). Clinical, mostly small and short-term, studies indicated that short-term adverse reactions of HIV-infected patients to UV therapy are rare (2-4). The HIV load increases in some patients undergoing UVB or PUVA therapy, and CD4+ T-cell count decreases during UVB treatment have been reported (4, 5) . With this limited information, we suggested that it is unlikely that UV therapies have clinically relevant effects on HIV disease in its final stage, when the immune system is already severely impaired, and