Skin rash

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viruses. But this defense depends on a functional immune system. when the immune system is suppressed, disorders of the skin may appear. organ transplantation and cancer patients who undergo immunosuppressive therapies may experience skin disorders such as Kaposi's sarcoma or herpes outbreaks. In HIV, lesions, dry skin, and blisters are common early in the course of the infection and may recur or become chronic. Skin diseases in HIV infection include molluscum contagiosum, herpes SIMPLEX VIRUS (HIV), HERPES ZOSTER (shingles), HAIRY leukoplakia, and folliculitis. Viral skin disorders common in HIV-infected people are not ordinarily life-threatening, but they can cause significant pain, illness, and cosmetic frustration. In some cases, viral skin diseases can spread to infect other parts of the body, possibly resulting in life-threatening conditions such as HIV encephalitis. Early detection, prophylaxis, and treatment of skin diseases are recommended. See sallowness; skin rash.

skin rash Texture and temperature of skin are important signs of underlying conditions. Rashes and their causes, like scars, are diagnostic. Redness is usually seen in inflammation, skin disease, chronic alcoholism, vasomotor disturbances, and pyrexia, as well as sunburn. Local redness with pain indicates inflammation. Lesions, bumps, dry skin, or blisters are common in early HIV infection and may be caused by a number of conditions or infections, including herpes zoster, herpes simplex, dermatitis, etc. See sallowness; skin disorder.

skin test A test of the immune system by means of injections of certain proteins just below the surface of the skin. If the immune system is intact, a rash appears within 48 hours at the site of injection.

skip-generation parenting A situation in which children are raised by grandparents instead of parents. Although data are scarce, it appears that when parents die of AIDS, children most often go to live, at least at first, with grandmothers or aunts. The problem of skip-generation parenting is not, however, solely attributable to HIV disease. use of drugs, especially crack cocaine, has devastated many families. Grandparents—and especially grandmothers, since women have traditionally taken on the role of family care giving—have taken over when their own children have been unable to take on parenting responsibilities or when they have chosen to move their children to a safer environment. This problem has particularly affected African-American communities.

Two general outcomes are predictable. First, some of these grandparents, no matter how willing and devoted they are, will be unable to continue to bear the burdens of child raising—and many of these children have severe behavior or academic problems—because of illness, age, emotional exhaustion, and poverty. Second, there will be no new generation of grandparents to take the place of this generation. The mothers and fathers lost to AIDS will become a lost generation of grandparents.

slim disease See hiv wasting disease.

slow virus A virus, such as HIV, that produces disease with a greatly delayed onset and protracted course. Diseases of a chronic degenerative nature that are now suspected to be due to slow viruses include subacute sclerosing panencephalitis and progressive multifocal leukoencephalopathy.

SMART (Strategies for Management of Antiretro-viral Therapy) A clinical trial sponsored by the Community Programs for Clinical Research on AIDS (CIPRA) of a size and duration designed to provide high-quality data about what happens to people who have been on antiretroviral therapy for more than a couple of years. Study plans include enrolling 6,000 people and following them for as long as nine years. The trial is the first randomized comparison of two viable but competing strategies for how to treat HIV. The study is open to both treatment-nai've and treatment-experienced HIV-positive people above the age of 13 who have CD4 counts above 350 cells/mm. The only other requirement is a willingness to have an open mind about the optimal way to use antiretroviral therapy for the best long-term outcome. Participants are randomly assigned to one of two camps—one group will follow the classic path of making every effort to keep their viral loads undetectable at all times (the viral suppression group), and the other will follow a strategy of avoiding treatment, despite

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