Dermatological manifestations in human immunodeficiency virus infected patients: Morphological spectrum with CD4 correlation

Abstract

Background:More than 90% of human immunodeficiency virus (HIV) infected patients develop skin lesions at some time throughout the course of the disease. Several skin diseases have proved to be sensitive and useful indicators of progression of HIV infection. Although these conditions may be seen in general healthy population, their occurrence in patients with acquired immunodeficiency syndrome is often atypical, more severe and explosive.Aims:The present study was carried out to categorize the skin lesions by histopathology using punch biopsy or cytology when feasible in HIV infected patients and to see the correlation for various skin lesions with CD4 counts.Materials and Methods:In total 110 known HIV positive patients with the symptomatic skin lesions, cytology and punch biopsy was correlated with CD4 counts.Results:Maximum patients were between 31 and 40 years. 53 (48.18%) patients had infectious and 37 (34.55%) patients had non-infectious lesions. Out of 110 patients, CD4 counts were available in 70 patients. The spectrum of various non-infectious and infectious lesions such as viral, bacterial, fungal, protozoa and their association with CD4 counts is discussed.Conclusions:CD4 counts below 200 were associated with the maximum infectious lesions, whereas CD4 counts more than 350 showed more of the non-infectious lesions. Most common infectious lesion was Molluscum contagiosum. The most common non-infectious lesion was pruritic papular eruptions.

Dermatological Manifestations In Human Immunodeficiency Virus Infected Patients: Histopathology And CD4 Cell Count Correlation

“…[12] Nichols et al stated that bacterial infections in AIDS were often under represented. [13] In our study we found 08 (13.3%) cases of bacterial infection including Mycobacterium infections as compared to 14 (12.72%) cases of bacterial infection in the study by Sanjay M Chawhan et al [5] Dermatological lesions of tuberculosis (TB) infection are rarely found in Western countries. [14] Various mycobacterium lesions in our study were leprosy (three cases of borderline tuberculoid and one case of tuberculoid leprosy), papulonecrotic tuberculid, scrofuloderma and TB cutis orificialis one each.…”

“…In the study by Sanjay M. Chawhan maximum infectious lesions were of viral etiology. [5] Maximum patients showed CD4 counts <350 as studied by other authors.The HPV related lesions were verruca vulgaris, verruca plana and bowenoid papulosis and condylomata accuminata. Muñoz-Pérez et al found no significant difference between the incidence of condyloma acuminata or verruca vulgaris in stage III and stage IV disease or with CD4 counts.…”

“…Which is similar to the results of the study done by Sanjay M. Chawhan et al which show Maximum number of infective lesions in patients with CD4 counts below 350 whereas patients with CD4 count above 350 showed minimum infective, but most of the non-infectious lesions. [5] Previous studies showed that CD4 counts <200 cells/cumm were associated with more number of infectious lesions. [4,8,9,10,11] Muñoz-Pérez (1998) stated that various dermatoses such as genital herpes, tinea, Kaposi's sarcoma, xerosis, HSV, drug eruptions, candidial folliculitis, M. contagiosum, psoriasis, abscess, verruca vulgaris, PPE, oral hairy leukoplakia and seborrheic dermatitis could be used as clinical markers of disease progression due to their strong association with CD4 counts.…”

“…In the study conducted by Sanjay M. Chawhan et al most of the patients were from 31 to 40 years age group. [5] In the study conducted by Nirja jindal [6] most affected age group was 21-40 years constituting 73.7% and a second peak in the age group >40 years with 21%. A study by Kumarasamy et al had 50% patients between 18 and 30 years age group.…”

“…The study conducted by Sanjay M. Chawhan et al showed 67% male patients as compared with 33% females. [5] A study done by Nirja jindal showed female preponderance with a male to female ratio of 0.9:1.…”