International http://std.sagepub.com/ Journal of STD & AIDS
Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count Michelle S Fernandes and Ramesh M Bhat Int J STD AIDS published online 10 July 2014 DOI: 10.1177/0956462414543121 The online version of this article can be found at: http://std.sagepub.com/content/early/2014/07/10/0956462414543121
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[1–6] [PREPRINTER stage]
Int J STD AIDS OnlineFirst, published on July 10, 2014 as doi:10.1177/0956462414543121
Original research article
Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count
International Journal of STD & AIDS 0(0) 1–6 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462414543121 std.sagepub.com
Michelle S Fernandes1 and Ramesh M Bhat2
Abstract In this study, 100 HIV-positive cases (63 men, 37 women) with skin findings were included. The mean CD4 T cell count was 253.3 cells/cumm. A total of 235 dermatological manifestations were seen. The common infectious dermatoses were candidiasis (21%), Staphylococcal skin infections (20%), dermatophytoses (14%) and Herpes Zoster (6%). Among the non-infectious dermatoses were Papular Pruritic Eruptions (20%), xerosis/ichthyosis (20%) and Seborrheic Dermatitis (16%). Statistically significant association (p < 0.05) with CD4 T cell count was seen in pyodermas, dermatophytoses and Papular Pruritic Eruptions. Adverse drug reactions, diffuse hair loss, straightening of hairs and pigmentary changes were also noted. Although there was an absence of Kaposi’s sarcoma in our study, a case of verrucous carcinoma of penis was noted.
Keywords HIV infection, CD4 T cell count, mucocutaneous manifestations Date received: 28 February 2014; accepted: 15 June 2014
Introduction Human immunodeficiency virus (HIV) infection is often associated with various skin disorders, some of which may be the presenting signs of the disease. They contribute significantly to patient morbidity in terms of quality of life and may also reflect the progress of HIV disease. Cluster of Differentiation (CD4þ) T lymphocyte count is one of the essential investigations and the best indicator of the current immunological competence of the HIV patient.1 However, the standard test for CD4 T cell count requires sophisticated laboratory facilities, is expensive and is not readily available in resource poor settings. Cutaneous manifestations are prominent affecting 86–96% of HIV-infected persons.1–4 The skin lesions or combinations of skin conditions are so unique that the diagnosis of HIV/AIDS can often be suspected from the skin examination alone. The skin conditions often tend to appear at a specific stage in the progression of HIV, and like CD4 T cell count, may be an
indicator of the development of AIDS and overall survival.2,3 The present study was undertaken to note the different mucocutaneous lesions present in the HIV population and correlate their severity with the declining immunity as indicated by CD4 T cell count.
Material and methods This prospective study included 100 HIV seropositive patients having skin findings, attending Dermatology outpatient department of Fr. Muller Medical College,
1 Department of Dermatology, Venereology and Leprosy, KS Hegde Medical Academy, Mangalore, India 2 Department of Dermatology, Venereology and Leprosy, Fr Muller Medical College, Mangalore, India
Corresponding author: Michelle S Fernandes, ‘‘Fatima Blocks’’, Jeppu Seminary View 3rd Cross, Mangalore 575002, Karnataka, India. Email: [email protected]
Downloaded from std.sagepub.com at OhioLink on October 13, 2014
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(STD)
[1–6] [PREPRINTER stage]
2
International Journal of STD & AIDS 0(0) Table 1. Distribution pattern of various infectious dermatoses in relation to CD4 count and their mean CD4 count. CD4 count (in cells/cumm) Infections
Mean CD4 count (in cells/cumm)
500
p*
Pyodermas Dermatophytoses Candidiasis Herpes Zoster HSV infection HPV infection Scabies Molluscum contagiosum
250.2 148.9 249.5 99.76 144.2 104.25 263 136.45 193.2 202.27 182.4 104.13 158.83 90.75 311 125.98
10 6 14 2 5 3 7 2
6 9 6 6 2 2 3 2
2 0 1 0 1 0 0 0
Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count Michelle S Fernandes and Ramesh M Bhat Int J STD AIDS published online 10 July 2014 DOI: 10.1177/0956462414543121 The online version of this article can be found at: http://std.sagepub.com/content/early/2014/07/10/0956462414543121
Published by: http://www.sagepublications.com
Additional services and information for International Journal of STD & AIDS can be found at: Email Alerts: http://std.sagepub.com/cgi/alerts Subscriptions: http://std.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Jul 10, 2014 What is This?
Downloaded from std.sagepub.com at OhioLink on October 13, 2014
XML Template (2014) [7.7.2014–2:37pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/STDJ/Vol00000/140129/APPFile/SG-STDJ140129.3d
(STD)
[1–6] [PREPRINTER stage]
Int J STD AIDS OnlineFirst, published on July 10, 2014 as doi:10.1177/0956462414543121
Original research article
Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count
International Journal of STD & AIDS 0(0) 1–6 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462414543121 std.sagepub.com
Michelle S Fernandes1 and Ramesh M Bhat2
Abstract In this study, 100 HIV-positive cases (63 men, 37 women) with skin findings were included. The mean CD4 T cell count was 253.3 cells/cumm. A total of 235 dermatological manifestations were seen. The common infectious dermatoses were candidiasis (21%), Staphylococcal skin infections (20%), dermatophytoses (14%) and Herpes Zoster (6%). Among the non-infectious dermatoses were Papular Pruritic Eruptions (20%), xerosis/ichthyosis (20%) and Seborrheic Dermatitis (16%). Statistically significant association (p < 0.05) with CD4 T cell count was seen in pyodermas, dermatophytoses and Papular Pruritic Eruptions. Adverse drug reactions, diffuse hair loss, straightening of hairs and pigmentary changes were also noted. Although there was an absence of Kaposi’s sarcoma in our study, a case of verrucous carcinoma of penis was noted.
Keywords HIV infection, CD4 T cell count, mucocutaneous manifestations Date received: 28 February 2014; accepted: 15 June 2014
Introduction Human immunodeficiency virus (HIV) infection is often associated with various skin disorders, some of which may be the presenting signs of the disease. They contribute significantly to patient morbidity in terms of quality of life and may also reflect the progress of HIV disease. Cluster of Differentiation (CD4þ) T lymphocyte count is one of the essential investigations and the best indicator of the current immunological competence of the HIV patient.1 However, the standard test for CD4 T cell count requires sophisticated laboratory facilities, is expensive and is not readily available in resource poor settings. Cutaneous manifestations are prominent affecting 86–96% of HIV-infected persons.1–4 The skin lesions or combinations of skin conditions are so unique that the diagnosis of HIV/AIDS can often be suspected from the skin examination alone. The skin conditions often tend to appear at a specific stage in the progression of HIV, and like CD4 T cell count, may be an
indicator of the development of AIDS and overall survival.2,3 The present study was undertaken to note the different mucocutaneous lesions present in the HIV population and correlate their severity with the declining immunity as indicated by CD4 T cell count.
Material and methods This prospective study included 100 HIV seropositive patients having skin findings, attending Dermatology outpatient department of Fr. Muller Medical College,
1 Department of Dermatology, Venereology and Leprosy, KS Hegde Medical Academy, Mangalore, India 2 Department of Dermatology, Venereology and Leprosy, Fr Muller Medical College, Mangalore, India
Corresponding author: Michelle S Fernandes, ‘‘Fatima Blocks’’, Jeppu Seminary View 3rd Cross, Mangalore 575002, Karnataka, India. Email: [email protected]
Downloaded from std.sagepub.com at OhioLink on October 13, 2014
XML Template (2014) [7.7.2014–2:37pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/STDJ/Vol00000/140129/APPFile/SG-STDJ140129.3d
(STD)
[1–6] [PREPRINTER stage]
2
International Journal of STD & AIDS 0(0) Table 1. Distribution pattern of various infectious dermatoses in relation to CD4 count and their mean CD4 count. CD4 count (in cells/cumm) Infections
Mean CD4 count (in cells/cumm)
500
p*
Pyodermas Dermatophytoses Candidiasis Herpes Zoster HSV infection HPV infection Scabies Molluscum contagiosum
250.2 148.9 249.5 99.76 144.2 104.25 263 136.45 193.2 202.27 182.4 104.13 158.83 90.75 311 125.98
10 6 14 2 5 3 7 2
6 9 6 6 2 2 3 2
2 0 1 0 1 0 0 0
