Highly active antiretroviral therapy leading to resolution of porphyria cutanea tarda in a patient with AIDS and hepatitis C

The association between HIV infection and porphyria cutanea tarda (PCT) is not well established. Since almost all HIV-infected patients with PCT previously described in the literature had additional risk factors for PCT, it is still unclear if HIV infection and not a cofactor such as hepatitis C virus is the trigger for PCT in this population. We describe a patient with AIDS and hepatitis C who developed bullous lesions due to PCT. The cutaneous lesions persisted for 18 months and resolved after he was placed on highly active antiretroviral therapy for HIV. No other therapeutic interventions were undertaken, while exposure to other known precipitants remained unchanged. During follow-up, skin lesions reappeared when the patient discontinued antiretroviral therapy, but PCT lesions again resolved after he restarted highly active antiretroviral therapy and HIV infection was controlled. This case supports the hypothesis that a direct causative relationship exists between HIV and the development of PCT.