Skin manifestations of HIV-1 infection in children

A small molecule that targets the processivity factor of molluscum contagiosum virus has therapeutic potential

Molluscum contagiosum (MC) is an infectious disease that occurs only in humans with a tropism that is narrowly restricted to the outermost epidermal layer of the skin. Molluscum contagiosum virus (MCV) is the causative agent of MC which produces skin lesions that can persist for months to several years. MCV is efficiently transmitted by direct physical contact or by indirect contact with fomites. MC is most prevalent in children and immune compromised patients. The failure to develop a drug that targets MCV replication has been hampered for decades by the inability to propagate MCV in cell culture. To address this dilemma, we recently engineered a surrogate poxvirus expressing the MCV processivity factor (mD4) as the drug target. The mD4 protein is essential for viral replication by keeping the viral polymerase tethered to the DNA template. In this study we have designed and synthesized a lead compound (7269) that is able to prevent mD4 dependent processive DNA synthesis in vitro (IC50 = 6.8 μM) and effectively inhibit propagation of the mD4-VV surrogate virus in BSC-1 cells (EC50 = 13.2 μM) with negligible cytotoxicity. In human liver microsomes, 7269 was shown to be stable for almost 2 h. When tested for penetration into human cadaver skin in a formulated gel, the level of 7269 in the epidermal layer was nearly 100 times the concentration (EC50) needed to inhibit propagation of the mD4-VV surrogate virus in BSC-1 cells. The gel formulated 7269 was scored as a non-irritant on skin and shown to have a shelf-life that was completely stable after several months. In summary, 7269 is a potential Lead for becoming the first MCV anti-viral compound to treat MC and thereby, addresses this unmet medical need that has persisted for many decades.

Surgical implications of HIV infection

According to the joint United Nations Programme on HIV/AIDS (UNAIDS), 37.7 million adults and children worldwide were estimated to be living with HIV or acquired immune deficiency syndrome (AIDS) at the end of 2020 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. Most reside in low- and middle-income countries, with approximately 67% in sub-Saharan Africa (SSA). At the end of 2020, the total number of children less than 15 years of age living with HIV infection was 2.6 million, of whom 2.3 million (88%) were living in SSA. Aggressive interventions have reduced the annual number of incident (new) HIV infections among children to around 150,000 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. However, paediatric HIV infection remains a pandemic affecting children predominantly in SSA but is also seen in Asia and sporadically elsewhere particularly in areas of civil strife such as is currently the case in Ukraine [War in Ukraine. (2022). https://www.unaids.org/en/War-Ukraine-special . Accessed Apr 2022]. New HIV infections among children declined by more than half (54%) from 2010 to 2020, due mainly to the increased provision of antiretroviral therapy to pregnant and breastfeeding women living with HIV [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. These programmes include early identification of HIV infection in pregnant or breastfeeding women through routine HIV testing, provision of antiretroviral therapy (ART) to all HIV-infected women who are pregnant or breastfeeding, provision of antiretroviral prophylaxis to their newborn infants during the first 6-12 weeks of life, delivery by elective Caesarean section when indicated, promotion of exclusive breastfeeding, early infancy screening for HIV infection, and initiation of ART in infants with HIV infection. HIV-infected children may require surgery either as an emergency to deal with a life-threatening incidental condition unrelated to HIV infection or for a complication of the disease such as tuberculosis or an aggressive soft tissue infection like necrotising fasciitis. Non-emergency surgical procedures may be required to assist in the diagnosis of an HIV-related condition or to correct a routine surgical problem electively. Surgical conditions associated with HIV infection are described under categories of soft tissue or organ-specific infections requiring drainage or debridement; gastrointestinal tract disease and complications; infections in the perineal area; malignancies and HIV-associated vasculitis. Although surgical outcomes are less favourable in HIV-infected children, pre-operative treatment of coinfections, administration of cotrimoxazole prophylaxis, nutritional support and antiretroviral therapy, together with peri-operative antibiotic prophylaxis have resulted in excellent short-term outcomes [World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, June 201 http://www.apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf?ua=1 ; World Health Organization Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, September 2015. http://www.apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1;Eley et al. in BMC Infect Dis 2:3, 2002;Karpelowsky et al. in Pediatr Surg Int 28:1007-1014, 2012;].

Self-reported Dermatological Manifestations, Perceived Stress, and Body Image of Young Adults During the Greek Lockdown Caused by the COVID-19 Outbreak

The aim of the study is to explore the perceived impact of social distancing measures due to COVID-19 on the manifestation of skin disorders and symptoms and their association with perceived stress and body image. For the purposes of this article, quantitative-driven mixed methods are used: the Greek versions of “Perceived Stress Scale” (Andreou et al., International Journal of Environmental Research and Public Health 8:3287–3298, 2011) to measure the stress levels among population, and “Multidimensional Body-Self Relations Questionnaire-Appearance Scales” (Argyrides and Kkeli, Psychological Reports 113:885–897, 2013) to examine body image satisfaction and assessment, along with open-ended questions are used. Questionnaires were distributed during the period of social distancing measures and 3 weeks following lockdown. Two hundred and fifty-three (N = 253) participants completed the survey: a control group of 164 participants without dermatological manifestations and a study group (N = 89) with dermatological manifestations.. Statistical analysis shows that adults with acne have a higher sense of self-efficacy in managing stressful situations than participants who have other skin disorders. Gender differences are observed as far as the perceived appearance is concerned. Thematic content analysis (Braun and Clarke, Qualitative Research in Psychology 3:77–101, 2006) shows that adults with skin symptoms associate their symptoms exacerbation with intrapersonal dimensions, such as stress and fear and environmental factors. The presence of skin disease is not necessarily associated with body satisfaction, body image, and cutaneous body image, although positively correlated with stress. The results are discussed and future recommendations are proposed.

Contributing Factors and Outcome after Cryotherapy of Molluscum Contagiosum among Patients Attending Tertiary Hospital, Northern Tanzania: A Descriptive Prospective Cohort Study

Background

Molluscum contagiosum (MC) is a benign infection caused by a member of the Poxviridae family, molluscum contagiosum virus (MCV). The contributing factors for MCV infection are different in different populations and study areas. Few studies have been conducted to determine the effectiveness of cryotherapy in the treatment of MC. The study's objectives were to determine contributing factors and outcome after cryotherapy of MC among patients attending a tertiary hospital in Northern Tanzania.

Methods

A hospital-based cohort study was conducted at the Regional Dermatology Training Centre (RDTC) from September 2018 to August 2019, involving all patients clinically diagnosed with MC. We used a consecutive sampling method to recruit study participants. We treated all participants with cryotherapy and assessed them after two weeks. Data were collected using a structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) software version 21.

Results

There were 49 patients with MC who agreed to participate in this study with a median age of 8 (IQR 3–22). We found 18.4% of patients with active atopic dermatitis (AD) had MC while those with a history of atopic diseases (Ad) were 32%, and 22.4% had a history of using immunosuppressive drugs. The clearance rate of cryotherapy on MC lesions was found to be 94%. Hypopigmentation was the commonest adverse effect.

Conclusion

The findings of this study show that AD and immunosuppression may be contributing to MC development. Based on the clearance rate results, cryotherapy has shown to be effective and may be used in the treatment of MC.

Skin manifestations of malnutrition in HIV-positive meningitis patients

Background

HIV infection and meningitis are diseases which are known to precipitate malnutrition. Skin manifestations of malnutrition are easy to identify. We tried to describe the skin manifestations of malnutrition in HIV-positive patients with meningitis.

Setting

Patients included in the study were from a tertiary referral hospital in South India.

Methods

In a cross-sectional observational design, we studied 56 adult [> 14 years] HIV-seropositive patients with meningitis by clinical assessment of skin manifestations of malnutrition.

Results

Skin wasting (31.5%), hyperpigmentation of skin (22.2%) and skin ulceration (16.4%) were the chief skin manifestations of malnutrition in HIV-positive patients with meningitis.

Conclusions

Our study shows that certain cutaneous features of malnutrition like skin ulcers, skin wasting and hypo pigmentation are common in HIV patients with meningitis.

Treatment of molluscum contagiosum in adult, pediatric, and immunodeficient populations

BACKGROUND

Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by recalcitrance to treatment and remains a significant cause of morbidity worldwide.

OBJECTIVE

The purpose of this review was to compile an updated resource for clinicians that addresses the management of the broad spectrum of molluscum cases that may be encountered.

METHODS

A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection, including presentations that may be rare or difficult.

RESULTS

The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain treatments can be more effective for specific patient subpopulations.

CONCLUSION

Further attention must be directed toward standardizing treatment for molluscum infection based on patient age and immune status.

Temporal trends in mucocutaneous findings among human immunodeficiency virus 1-infected children in a population-based cohort

The objective of the study was to determine the prevalence of pediatric human immunodeficiency virus 1 (HIV-1) mucocutaneous manifestations in the era of highly active antiretroviral therapy (HAART). We conducted population-based, prospective, multicenter pediatric HIV-1 surveillance in 276 children with perinatally acquired HIV-1 from 1988 to 2009. Centers for Disease Control and Prevention (CDC)-defined HIV-1 related mucocutaneous conditions among the 276 children were: category A (n = 152), B (n = 60), and C (n = 1). Nearly half of the category A and B diagnoses (43.4% [66/152] and 35.0% [21/60], respectively) occurred in the first year of life, with 59.2% (90/152) and 61.7% (37/60), respectively, occurring in the first 2 years of life. The most frequent infectious diagnosis was oropharyngeal thrush (n = 117, 42.4%); the most common inflammatory diagnosis was diaper dermatitis (n = 71, 25.7%). There was a temporal decline in the prevalence of A (pre-HAART cohort, 123; post-HAART cohort, 29; p < 0.01) and B (pre-HAART, 55; post-HAART, 5; p < 0.01) mucocutaneous diagnoses. In children with perinatal HIV-1, there was a significant decline in CDC category A and B mucocutaneous diagnoses by temporal cohort, consistent with the introduction of antiretroviral medications and HAART. Clinical category A and B mucocutaneous diagnoses were most common in the first 2 years of life, emphasizing the importance of early HIV-1 testing and HAART initiation.

Common skin conditions in children with HIV/AIDS

The most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) data inform us that approximately 2.3 million children were infected with HIV at the end of 2009. The greatest burden of this infection is thrust squarely on the most impoverished healthcare systems in the world. Sub-Saharan Africa is home to at least 68% of the global total of HIV infection of 22.5 million. Although a scale up of antiretrovirals has been one of the UNAIDS priorities, and access to services to prevent mother-to-child transmission has increased, an estimated 370,000 children were newly infected in 2009. Hence, infected mothers continue giving birth to HIV-infected children who require appropriate healthcare to diagnose and treat their underlying immunodeficiency and related disorders. Skin lesions are common in these children as they present with infections common in the general population, albeit more severe. Those lesions that are markers of HIV or AIDS are important signs heralding an improving or declining immune system and the success of antiretrovirals. Cutaneous manifestations of HIV/AIDS can be classified broadly as infections and infestations, inflammatory conditions, tumors, and antiretroviral related. This manuscript discusses the more common skin conditions seen in children infected with HIV so as to improve the diagnosis and therapy administered by healthcare professionals especially in sub-Saharan Africa.

Surgical implications of human immunodeficiency virus infections

Pediatric HIV (human immunodeficiency virus) is a pandemic predominantly in sub-Saharan Africa. Approximately 2.2 million children aged less than 15 years are infected with HIV, representing almost 95% of the total number of children globally infected with HIV. Therefore, increasing numbers of HIVi or -exposed but uninfected children can be expected to require a surgical procedure to assist in the diagnosis of an HIV/acquired immune deficiency syndrome-related complication, to address a life-threatening complication of the disease, or for routine surgery encountered in HIV-unexposed children. HIVi children may present with both conditions unique to HIV infection and surgical conditions routine in pediatric surgical practice. HIV exposure confers an increased risk of complications and mortality for all children after surgery, whether they are HIV infected or not. This risk of complications is higher in the HIVi group of patients. These findings seem to be independent of whether patients undergo an elective or emergency procedure, but the risk of an adverse outcome is higher for a major procedure. Surgical implications of HIV infection are comprehensively reviewed in this article.

Disseminated varicella zoster virus in an immunized child as the acquired immunodeficiency syndrome-defining illness

Varicella zoster virus (VZV) immunization aids in the prevention of future VZV infections in immunocompetent patients; however, severely immunocompromised patients remain at increased risk of VZV infection. We report a case of a 10-year-old boy previously immunized to Varicella who presented with herpes zoster with hematogenous dissemination as the Acquired Immunodeficiency Syndrome-defining illness. Disseminated VZV is more commonly seen in human immunodeficiency virus (HIV)-infected individuals with more advanced disease, as was the case with our patient. Disseminated VZV infection in a previously immunized child should raise suspicion for underlying immunosuppression.

Pediatric HIV/AIDS and the skin: an update

In 2005 there were 2.1 million children under the age of 15 years living with HIV in sub-Saharan Africa. As in the adult pandemic, attendant skin disease is prevalent in children. This article provides an update of pediatric HIV/AIDS and its cutaneous manifestations from four main aspects: epidemiology, skin disease as an indicator of immune status, immune reconstitution inflammatory syndrome, and the impact of antiretroviral agents on skin disease.