Mucocutaneous disorders in HIV/AIDS at a tertiary care hospital in Nepal: An observational study

Abstract

Background: Mucocutaneous manifestations in HIV infections are common. However, they have not, so far, been studied in Nepal. The aim of this study was, therefore, to describe mucocutaneous manifestations in Nepalese HIV patients. Materials and Methods: The following is a hospital-based, descriptive, cross-sectional study conducted in the Department of Dermatology and Venereology and Antiretroviral Treatment (ART) Center of Tribhuvan University Teaching Hospital (TUTH) from May 2017, through October 2018. Patients aged 16 years and above diagnosed with HIV were included in the study, for whom history and clinical examinations were performed. The study variables were age, sex, a clinical diagnosis of dermatological problems, clinical stages of HIV/AIDS, as per the World Health Organization (WHO) classification criteria, and the CD4 count. Results: A total of 52 patients were included in the study. The mean age upon presentation was 38.77 ± 10.9 years. The mean CD4 count was 464.27 ± 255.13. Females were more affected than males (female:male = 1.4:1). Mucocutaneous manifestations were the following: fungal infections (10; 19.3%), viral infections (6; 11.6%), parasitic infestations (3; 5.8%), bacterial infections (4; 7.7%), sexually transmitted infections (2; 3.8%), seborrheic dermatitis (3; 5.8%), idiopathic pruritus (3; 5.8%), recurrent oral ulcers (3; 5.8%), urticaria (3; 5.8%), pruritic papular eruptions (2; 3.8%), eczemas (2; 3.8%), acne (2; 3.8%), angular cheilitis (2; 3.8%), xerosis cutis (2; 3.8%), and others (5; 9.6%). Conclusions: The study showed that fungal infections are common in HIV patients, followed by viral infections and parasitic infestations. Seborrheic dermatitis, idiopathic pruritus, recurrent oral ulcers, and urticaria were found to be common inflammatory skin diseases in HIV.

Mucocutaneous Manifestations in HIV/AIDS Patients

“…In PLHIV, a prevalence of 8% has been found in other study. 15 The prevalence of Molluscum contagiosum was seen 0.5% in our study, and it is lower than prevalence in other study by Abhihandan et al (6%). 16 The lower frequency of herpes zoster in our study could again be attributed to early ART in our study population.…”

“…Their presence after at least 6 months of ART has been proposed as one of the several markers of treatment failure. 15 Xerosis was seen in 6% of our cases. The prevalence of xerosis in HIV/AIDS varies from 2.8% to 73.3%.…”

“…Sexually transmitted infections are one of the important manifestations of HIV/AIDS. 15 Human papillomavirus infections in our study caused condyloma accuminata in 54 patients and verruca vulgaris in 3 patients. The incidence of genital warts in various studies involving male patients ranged from 13.8% to 21.4%.…”

“…16 Another study showed that the prevalence of condyloma acuminata in HIV/AIDS ranges from 8.8% to 53%. 15 The fact that our patients were well-educated on barrier contraceptive measures and receiving positive prevention at our Antiretroviral Treatment (ART) center could have contributed to the lower rates of STI in our study. 15 The lower incidence in our study may be also due to reduced prevalence of homosexuality in our country.…”

“…This finding is greater compared to the results of reasearch by Abhinandan et al who also showed that pruritic papular eruptions were the most common noninfectious manifestation (13%). 15 Pruritic papular eruptions (PPE) constitutes the majority of cases in inflammatory or non-infectious dermatoses. PPE may appear as an early skin disease with a high CD4 cell count and is described as a stage II disease by WHO.…”