Skin diseases in HIV-infected patients: Impact of immune status and histological correlation.

Sir,

Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. Distinctive skin lesions occur at various WHO clinical stages of HIV infection. Extensive herpes zoster, seborrhoeic dermatitis, and oral candidiasis may act as indicators and their recognition is of particular importance for the early diagnosis of HIV infection and prevention of further opportunistic infections.

In our present study, first 50 of patients, above 14 attending Dermatology OPD who were diagnosed cases of HIV infection but not on ART and whose history, clinical examination data, skin biopsy report, and current CD4 T cell count were available, were included. The data were analyzed using Microsoft excel 2003 data analysis tool and SPSS 16.

Among the patients in this study, 58% (n=29) were male. So, the male to female ratio of this group was 1.38:1. The patients were mostly in 26–35 years age group (50%).

Out of 50 patients, 41 patients (82%, n=41) presented with stage II, 8% (n=4) presented with stage III, and 10% (n=5) presented with stage IV clinical symptoms of HIV disease spectrum (revised WHO clinical staging of HIV/AIDS for adults and adolescents, 2006).

In this study, 96% of the provisional diagnoses given clinically proved to be true after they were verified by histopathological methods.

The commonest dermatological disorder encountered in the present study was pruritic papular eruption (28%), followed by seborrhoeic dermatitis (24%), psoriasis (10%), molluscum contagiosum (10%), and drug reactions (8%). Sivayathorn et al.[1] found in Bangkok in 1995 that pruritic papular eruption (PPE) had a prevalence of 32.7%, SD 21%, and psoriasis 6.5% among HIV seropositives with skin lesion. In an Indian study at Vadodara, 120 out of 200 cases had noninfectious cutaneous manifestations such as pruritic papular eruption in 43 cases (35.8%), pigmentary changes in 10 cases (8.3%), seborrhoeic dermatitis in 5 cases (4.2%), and psoriasis in 4 cases (3.3%).[2]

Eosinophilic folliculitis [Figure 1] is said to occur at CD4 T cell count of 250–300/μl and therefore identifies patients at immediate risk of developing opportunistic infections.[3] Though we found only two cases of EF, their CD4 T cell count (276 and 290/μl) tally with the literature.

Figure 1

Eosinophilic folliculitis

Pruritic papular eruption, [Figure 2] the commonest skin disorder encountered in our study, presents as firm, discrete, sometimes excoriated, erythematous urticarial itchy papules associated with eosinophilia. In the present series, nine patients of PPE had lesions both on extremities and trunk, four had lesions only on extremities, and one had papules over face and arms. That last case was clinically diagnosed as EF but skin biopsy clinched the diagnosis of PPE [Table 1].

Figure 2

Pruritic papular eruption: Itchy tiny erythematous and skin colored papular eruptions mostly on extremities

Table 1

Skin disease distribution in patients of the study population

Definite statistical correlation between some specific skin diseases and CD4 T cell count was found in the present study. HIV-related cutaneous manifestations are very common and can be easily detected. If studied properly, they can serve as diagnostic and prognostic markers [Table 2].[2]

Table 2

Association between skin diseases and CD4 T cell count of patients