Abstract:
Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity
reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious
agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious
diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic
infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even
though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms
that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and
managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to
acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum,
histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4+T cells, it can also
directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8+T
cells against epithelial cells. HIV infection may also trigger EM directly when CD8+T cells recognize viral particles
on epithelial cells due to the hyperactivation of CD8+T-cells. The hyperactivation of CD8+T cells was similar to
that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM
has been well established. This includes the administration of other drugs to HIV-infected individuals to manage
opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This
article highlights the potential direct and indirect role that HIV infection may play in the development of EM and
the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may
require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity
reactions leading to EM.
