Jpn. J. Infect. Dis., 52, 1999

Laboratory and Epidemiology Communications

Improvement lof Onychomycosis without Antifungal Therapy after Initiation ofHighly Active Anti‑Retroviral Therapy (HAART) in an HIV‑Infected Patient
Natsuo Tachikawa, Akira Yasuokaand Shinichi Oka*AIDS Clinical CentelT, International Medical Center of Japan,
Toyama 1‑21‑1, Shinjuku‑ku, Tokyo 162‑8655

Communicated by Hiroshi Yoshikura(Accepted December 1 3, 1 999)

Immunodeficiency caused by the humanimmun∝leficiency

viruStypel 1 (HIV‑ I ) has produced many characteristic opp?r‑tunistic infections such as Pneumocystis cariml PneumOnla,

Kaposi 's sarcoma, cytomegalovirus retiniti s, Mycobacterium
avium complex bacteremia, and several fungal infections.

Most of these infections are progressive,and sometimes fatal
without specific therapleS. However, it has recently beenreported that the incidence of such infections was decreaslng( 1 ,2) and, further that some of them improved without specifictherapies, afterthe introduction of HAART (3, 4). We encoun‑
tered a case of onychomycosis that improved without anti‑

fungal therapy, after initiation of HAART including stavudine(d4T), lamivudine, and nelfinavir.

A Japanese homosexual man with HIV infection visited
our hospital because of syphilis. His CD4 count at the firstvisit was 27/mm3･ At that time, he had been suffering from

Fig. I. Recovenng onychomycosis on therightthumb atthe eighthweek (Novリ1997) after commencement of HAARr Asthe arrow

indicates, normalnail tissue replaced half of the part infected from

Matrix ungulS･

onychomycosis on the right thumb for more than a year. Hissyphilis was cured by penicillin treatment, then, HAART wasstarted in September, 1997. The onychomycosis began todidanosine/indinavir in March, 1998 when his viralload agaln

improve, withoutany specificantifungaltherapy, at the fourthincreased. His immunological and virological data (Fig･ 2)

week after commencement of HAART, when the patient's
CD4 Count rose t0 122/mm3. By the eighth week (November,1997), normal nail tissue had replaced half of the part infected

as well as onychomycosis continued to improve thereafter.

Before the HAART era, patients with advanced HIV‑ 1 infec‑
tion often suffered from dermal fungal infections. To ourfrom Matrix unguis (Fig. I), and by the 12thweek, whentheknowledge, this is the first case report of improvement ofCD4 count increased to I 15/mm3, the nail had regained normal

onychomycosis after initiation of HAART･ This caserepresentsthe importance of HAART not only for HIV therapy

tissues. HAART for this patient was changed to d4T/

d4T/3TCnVFV

d4'ⅣddVIDV

州 蜘 洲 150 1 0 50

HIV RNAI

温ノ一一HⅠVRNAI‑

I‑cD4′つJノ＼/

一‑ヽーA′､AtqS･97

ヽ

Scpも7Pt･97,■‑一■■‑一‑■Noy･97

Dec･97

JaJr98

Feb･98

ｨ爾MB798

Ap798

ー■‑I.̲⊥̲‑̲May･98

JtD98

Jd･98

Aq!･98

Sep･98Fig. 2. The clinical course ofanHIV‑ I infected patient who suffered from onychomycosis･

d4T, stavudine; 3TC, lamivudine; NFV, nclfinavir; ddI, didanosine; IDV, indinavir*Corresponding author: Fax: +81‑3‑5273‑5 193, E‑mail: oka@imcJ.
hosp. go.J p245

lMrhH一Jpn. J. Infect. Dis., 52, 1999
but for the control of onychomycosis.

therapy. AIDS, ll, 173ト1738.

2. Dorhingo, P., Guardiola, J. M. and Nolla, J. (1998): The
This work was supported by grants fromthe Ministry ofimpact of newantiretroviral reglmenS On HTV‑ass∝iatedHealth and Welfare of Japan, and the Organization of

hospital admissions and deaths. AIDS, 12, 529‑530.
3. Teofilo, E., Gouveia, J., Brotas, V.and da Costa, P. (1997):

Pharmaceutical Safety and Research (OPSR) of Japan.

Progressi ve multifocal leukoencephalopathy regression

with highly active antiretroviral therapy. AIDS, I I , 449.

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246