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HIV and Scabies
Jun 25, 2007

Hello Dr. Bob:

I am a 43 y/o male who has been HIV+ for 4 years and not on meds. Recently, when being retested, I discovered my t-cells had dropped to 278 and my viral load was about 100,000 copies. So...it appears I will be starting meds very soon if my lab retest shows a lack of improvement. In the past week, I began experiencing what appeared to me as mite or spider bites on my left hand. That quickly developed into a trail of small welts and they started popping up on other areas of my body..including my genitals. I travel a great deal and feared I may have contracted Scabies or bed bugs. Last night I went to the local emergency room and concluded I had scabies. I was prescribed Permethrin 5% topical ointment which I applied all over my body, incuding my head. My questions to you are: 1. How subsceptible is my partner, who is not HIV positive. Although we have not had any sexual contact in several days, we cuddle, kiss and hug frequently. Should he treat himself with the ointment as well? 2. Since I am HIV + and not yet on meds, should I also be on the oral medication called Ivermectin? 3. Once treated, what is the likelihood that the scabies will return and reinfest my body?

Your prompt response is greatly appreciated.

Response from Dr. Frascino

Hello,

1. Anyone can get scabies, regardless of their HIV serostatus. Scabies is caused by Sarcoptes scabiei, a small mite that burrows beneath the skin and causes intense itching. Symptoms usually begin two-six weeks after infection in persons who have never had scabies before. For those with reinfection, symptoms can begin in one-four days. Transmission occurs primarily via direct body-to-body contact, including, but not limited to, sexual contact. It can also be transmitted via contact with clothes and bedding. Treatment with permethrin cream 5% (Elimite) applied to the total body from the neck down and washed off 8 to 14 hours later with a retreatment 1-2 weeks later is usually successful. Ivermectin (Stromectol) is not recommended as a first line treatment in uncomplicated cases. All family members and close contacts must be treated simultaneously. Bedding and clothing must be decontaminated via machine washing in hot water followed by machine drying on high heat or with dry cleaning.

2. No, see above.

3. No increased risk over the general population, assuming you follow the guidelines above.

Good luck!

Dr. Bob



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