HIV: Inflammatory dermatoses

Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.

HIV-Related Oral Mucosa Lesions: A Cross-Sectional Study on a Cohort of Italian Patients

BACKGROUND

Human immunodeficiency virus (HIV) infection can be associated with oral mucosal diseases, including oral candidiasis and HPV infection, which are putative indicators of the immune status.

AIM AND METHODS

This retrospective cross-sectional study was aimed at assessing the prevalence of HIV-related oral mucosal lesions in a cohort of Italian HIV+ patients regularly attending the Clinics of Infectious Diseases.

RESULTS

One hundred seventy-seven (n = 177) patients were enrolled and 30 (16.9%) of them showed HIV-related diseases of the oral mucosa. They were mainly found in male patients over 35 years old, undergoing Combination Antiretroviral Therapy (cART), and with CD4+ count < 500/µL. Oral candidiasis was the most common HIV-related oral lesion. No significant correlations could be detected between the prevalence of HPV infection and other clinical parameters (lymphocyte count, cART treatment and viral load).

CONCLUSIONS

HIV-related oral mucosal diseases can correlate with immunosuppression. Early diagnosis and management of oral lesions in HIV+ patients should be part of the regular follow-up, from a multidisciplinary perspective of collaboration between oral medicine and infectious disease specialists, in an attempt to reduce morbidity due to oral lesions and modulate antiretroviral therapy according to the patient's immune status.

Blue Nail Discoloration: Literature Review and Diagnostic Algorithms

Blue nail discoloration is a distinctive clinical presentation, and diagnosis is challenging given the broad differential diagnosis. A comprehensive review of the literature describing blue discoloration of one or multiple nails was performed using the PubMed, Embase, Scopus, and Web of Science databases. A total of 245 publications were included and grouped based on involvement of a single nail (monodactylic) or multiple nails (polydactylic). Monodactylic blue discoloration was associated with tumors or benign nevi, most commonly glomus tumors, followed by blue nevi and less commonly melanomas. Polydactylic blue discoloration was frequently associated with medications (such as minocycline, zidovudine, and hydroxyurea), toxic and exogenous exposures (such as silver), and other medical conditions (such as HIV/AIDS and systemic lupus erythematous). Patients presenting with blue nail discoloration warrant a thorough history, physical examination, and workup to rule out malignancy, systemic disease, or toxic exposure. We present diagnostic algorithms for monodactylic and polydactylic blue nail discoloration to guide workup and treatment plans.

Global prevalence of oral pigmentation and its related factors: a systematic review and meta-analysis

BACKGROUND

Oral pigmentation is due to the accumulation of one or more pigments in tissues, causing changes in the color of the oral mucosal surfaces. Understanding the exact global prevalence of oral pigmentation and its associated factors helps researchers make the proper interventions at the right time; in this respect, the objective of the present systematic review and meta-analysis was to determine the global prevalence of oral pigmentation and its related factors.

METHOD

A systematic review and meta- analysis were conducted using the following databases: Magiran, SID, Scopus, Embase, PubMed, Web of Science (WoS), and Google Scholar. The search was run to retrieve articles published from inception until July 2021, and the following keywords were applied in the search strategy: "Epidemiolo*", "Prevalen*", "Factor*", "Pigment*", "Mouth", and "Oral". The I² index was used to assess the heterogeneity of the studies, and Egger's test was used to examine the publication bias.

RESULTS

Sixty-nine articles, with a sample size of 70,668 people, meeting the inclusion criteria were included in the study. The pooled of prevalence of oral pigmentation was estimated to be 20.8% (95% confidence interval: 17.1-1.25%). The prevalence of oral pigmentation raised significantly towards the end of the timespan covered by the study (P˂ 0.001). The majority of the examined studies reported that the prevalence of oral pigmentation is significantly higher in men, smokers or those exposed to secondhand smoke, people with fair skin, and who were affected by Yusho patients.

CONCLUSION

The results of the present study show that the prevalence of oral pigmentation is high, with higher prevalence in men, smokers or those exposed to cigarette smoke, people with fair skin, and Yusho patients compared to other groups. It is recommended that. these findings be used in policy makers' decisions to deliver better health care.

Mucocutaneous Manifestations of People Living with HIV in Current Antiretroviral Therapy Era

OBJECTIVE

It has been reported that approximately 90% of patients who are infected with human immunodeficiency virus (HIV) have various cutaneous symptoms that are related to the virus. This study aims to describe the cutaneous disorders that have developed in HIV-infected patients and to investigate the factors that may be related, such as relationships to drug use and CD4 counts.

METHODS

This cross-sectional study included people who were living with HIV and being followed by our hospital's infectious diseases clinic after they had been referred to the dermatology clinic because of skin lesions. These patients had been diagnosed with HIV by enzyme-linked immunosorbent assay tests and were included in the study if they were older than 18 years and had agreed to participate. Findings from detailed dermatological examinations were recorded, along with the patients' CD4 counts, the durations of their illnesses, and the treatments they received.

RESULTS

144 patients were included in the study. The most common mucocutaneous manifestation was seborrheic dermatitis, at 28.5% (n = 41). The mean CD4 count was 607.1 (min-max = 10.6-1982).The CD4 counts were divided into three groups in the study as follows: 22 (15.3%) patients with <200, 35 (24.3%) patients between 200 and 500, and 87 (60.4%) patients with >500. There were no statistical differences between these groups in terms of dermatological findings. Nevertheless, the highest rate of patients with three or more dermatological conditions was found among those with CD4 counts <200 (n = 11.50%).

CONCLUSION

Skin manifestations are common in patients who are HIV-positive; however, many skin disorders can be seen in HIV/acquired immunodeficiency syndrome (AIDS) patients whatever CD4 cell counts of these patients are.

Relationship between CD4+ count, serum inflammatory cytokines, and oral melanotic hyperpigmentation in newly diagnosed HIV-seropositive patients: a nested case-control study

OBJECTIVE

Oral melanotic hyperpigmentation (OMH) in patients with human immunodeficiency virus (HIV) infection has been attributed to the use of antifungal or antiretroviral drugs, as well as HIV-induced cytokine dysregulation. This research aimed to determine the relationship between immunosuppression and cytokine dysregulation in newly diagnosed HIV-seropositive subjects with OMH.

STUDY DESIGN

The study was conducted among newly diagnosed HIV-seropositive patients at the Infectious Disease Clinic, Ibadan, Nigeria. The cases were patients with OMH matched for age and sex with control subjects without OMH. CD4⁺ count and cytokine levels (interleukin-6 and tumor necrosis factor-α) were compared between the cases and control subjects. SPSS version 21 software was used for data analysis.

RESULTS

Seventy newly diagnosed HIV-seropositive patients were studied, which comprised of 35 cases and 35 control subjects. The median CD4⁺ counts for cases and control subjects were 174 cells/mm³ (interquartile range [IQR], 57-250) and 324 cells/mm³ (IQR, 107-424), respectively. Severe immunosuppression (CD4⁺ count, ≤200 cells/mm³) was found in over half of the study participants, being more prevalent among the cases than among the control group (P = .019). Serum cytokine levels did not significantly vary between the cases and control subjects.

CONCLUSIONS

There was a significant association between HIV-OMH and severe immunosuppression in the newly diagnosed HIV-seropositive patients.

Mucocutaneous diseases in the combined antiretroviral therapy era: prevalence and spectrum in HIV seropositive children and adolescents in Durban, South Africa

BACKGROUND

Mucocutaneous diseases (MCD) have been commonly described among human immunodeficiency virus (HIV) infected patients before the combined antiretroviral therapy (cART) era. There is limited data on the frequency and type of MCD in the cART era in African children and adolescents. This study aimed to describe the prevalence and spectrum of MCD in South African children and adolescents seropositive for HIV on cART.

METHODS

A cross-sectional study of 310 participants aged 0-19 years attending a public sector ART clinic at King Edward VIII Hospital, Durban, South Africa, was conducted. Demographic, clinical, and laboratory information was obtained from the participants and hospital records. Participants were examined. Data were collated and analyzed with SPSS version 23.

RESULTS

MCD were observed in 77.4% of HIV-infected children. The prevalence was higher among males and adolescents above 16 years old (83.9%). Infectious skin disorders (44.7%) were less common than noninfectious dermatoses (55.3%). More common disorders encountered included generalized pruritus (32.6%), fungal infections (20.9%), and inflammatory (20.4%) and pigmentary (20.4%) skin disorders. Tinea capitis and pedis were the most prevalent fungal infections, while oral candidiasis (0.2%) was the least. Inflammatory skin disorders and dyschromia appeared to be more common than in the pre-cART era.

CONCLUSIONS

While MCD are still common in HIV-infected children and adolescents in the cART era, the pattern and types of disorders have changed to a predominance of non-infectious dermatoses.

Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4 Lymphocyte Counts

BACKGROUND

More than 90% of human immunodeficiency virus- (HIV-) infected patients show at least one mucocutaneous manifestation during the course of their disease. The frequency, pattern, and associated factors of these complications vary among different populations.

OBJECTIVE

This study was planned to evaluate the frequency of cutaneous presentations in HIV-infected patients and their association with the count of CD4 cells.

METHODS

A cross-sectional study was conducted on eighty-four HIV-positive patients, who attended the Behavior Consultation Center of Arak University of Medical Sciences. All subjects had a complete physical examination by an expert dermatologist. Further diagnostic procedures were performed, if necessary. Counts of CD4 were determined using flow cytometry.

RESULTS

From 84 patients who enrolled in this study, 95.2% manifested at least one type of mucocutaneous lesions. The most common presentation was xerosis, followed by seborrheic dermatitis, herpes simplex, and oral candidiasis. Oral candidiasis and furuncle were significantly associated with decrease in CD4 cell counts.

CONCLUSIONS

Cutaneous manifestations are common in HIV-positive patients, some of which (oral candidiasis and furuncle) could be applicable as useful clinical indicators to predict the immune status of the patients. Therefore, regular skin examinations are recommended as routine HIV-infected patients' healthcare programs.

Effects of CD4 cell count and antiretroviral therapy on mucocutaneous manifestations among HIV/AIDS patients in Yunnan, China

BACKGROUND

The affecting factors of mucocutaneous manifestations in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients remain unclear in China.

METHODS

A retrospective analysis was conducted among HIV/AIDS patients in Yunnan, China. The demographic data, mucocutaneous manifestations, CD4 cell counts, and antiretroviral therapy (ART) regimens were collected. The effects of CD4 cell count and ART on the spectrum of mucocutaneous manifestations were evaluated.

RESULTS

Among 508 HIV/AIDS patients, 86.0% of cases showed mucocutaneous manifestations. The average CD4 cell count (176 cells/μl) of the patients with manifestations was significantly lower than those without manifestations (328 cells/μl) (P < 0.001). Diseases such as herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, cryptococcosis, and HIV-PPE (pruritic papular eruption) were represented quite frequently in patients with CD4 cell count <200 cells/μl (P < 0.05), but eczema was suffered by those with CD4 cell count ≥200 cells/μl (P < 0.05). ART could decline the incidence of herpes zoster, oral candidiasis, condyloma acuminatum, genital herpes, oral leukoplakia, talaromycosis, and cryptococcosis (P < 0.05).

CONCLUSIONS

Mucocutaneous manifestations are closely related to the CD4 cell count and can be used as early predictors of HIV/AIDS and immune status in clinic. ART could reduce the incidence of certain mucocutaneous manifestations.

Mucocutaneous manifestations in human immunodeficiency virus (HIV)-infected patients in Nouakchott, Mauritania

BACKGROUND

Mucocutaneous manifestations are one of the first clinical signs in patients infected with human immunodeficiency virus (HIV). To the best of our knowledge, there has been no previous study describing dermatologic manifestations in Mauritanians infected with HIV. The aim of the present study was to determine the profiles of mucocutaneous manifestations in relation to CD₄ T cell count in HIV-positive Mauritanian patients.

METHODS

A total of 86 adult patients aged > 18 years old attending the Ambulatory Treatment Center of the National Hospital of Nouakchott, Mauritania, with newly diagnosed HIV and who were not under antiretroviral treatment were included in the study in 2015. Dermatologic manifestations were documented before initiating antiretroviral treatment.

RESULTS

Most of the included patients were in clinical stage 3 of the World Health Organization classification at initial diagnosis, with the mean CD₄ T cell count (± SD) of 514 ± 319 cells/mm³ (range, 2-1328 cells/mm³ ), and 19 of 86 (22.1%) patients had CD₄ T cell counts below 200 cells/mm³ . More than half (64%) of newly diagnosed HIV-infected patients had dermatoses, including the following: pruritic papular eruption (44.2%), seborrheic dermatitis (4.7%), Kaposi's sarcoma (3.5%), extensive xerosis cutis (2.3%), drug-induced skin reactions (1.2%), and various infectious dermatoses (dermatophyte infections [16.3%], oral candidiasis [11.6%], herpes zoster [8.1%], and scabies [2.3%]). A low CD₄ T cell count (< 200 cells/mm³ ) was significantly correlated (P < 0.05) with the presence of following dermatoses: dermatophytosis, oral candidiasis, Kaposi's sarcoma, seborrheic dermatitis, and extensive xerosis cutis.

CONCLUSION

Mucocutaneous lesions occur throughout the course of HIV infection, and dermatologic findings in Mauritanian HIV-positive patients are similar to those of patients in other countries. Early detection of skin disorders in some patients may help establish the diagnosis of HIV and management of HIV-associated diseases, limiting the cost of care in low-resource countries.

Accelerated nail growth rate in HIV patients

BACKGROUND

Many factors have been noted to alter the growth rate of both finger and toe nails, some with harder evidence than others. Infectious diseases are among the ones reported as slowing the growth rate. However, on previous studies we noticed that patients living with HIV and onychomycosis could be cured without the use of antifungal therapy, only with the immunological improvement provided by the combined antiretroviral therapy, and we wanted to prove that the growth rate is also increased in this group and thus probably contributes to the cure of onychomycosis.

METHODS

This was an observational, descriptive, and prospective study. We marked with a scalpel the nail plate of the first finger of the non-dominant hand and the same foot, and measured the nail growth in the subsequent medical appointments with a magnifying glass and a millimetric scale.

RESULTS

Thirteen patients completed the study, and were paired with healthy controls by age and gender. After performing Mann-Whitney U test, our results showed statistical significance among both groups, showing that patients with HIV have faster nail growth rates than those in the HIV negative group.

CONCLUSIONS

There is little data on HIV nail growth rate to compare our results, but what we see in the clinical practice is that this group of patients shows a faster nail growth rate, as has also been reported for longer eyelashes, and this could be an important factor in the cure rates of onychomycosis.

Biology of the eyelash hair follicle: an enigma in plain sight

Because of their crucial impact on our perception of beauty, eyelashes constitute a prime target for the cosmetic industry. However, when compared with other hair shafts and the mini-organs that produce them [eyelash hair follicles (ELHFs)], knowledge on the biology underlying growth and pigmentation of eyelashes is still rudimentary. This is due in part to the extremely restricted availability of human ELHFs for experimental study, underappreciation of their important sensory and protective functions and insufficient interest in understanding why they are distinct from scalp hair follicles (HFs) (e.g. ELHFs produce shorter hair shafts, do not possess an arrector pili muscle, have a shorter hair cycle and undergo greying significantly later than scalp HFs). Here we synthesize the limited current knowledge on the biology of ELHFs, in humans and other species, their role in health and disease, the known similarities with and differences from other HF populations, and their intrinsic interethnic variations. We define major open questions in the biology of these intriguing mini-organs and conclude by proposing future research directions. These include dissecting the molecular and cellular mechanisms that underlie trichomegaly and the development of in vitro models in order to interrogate the distinct molecular controls of ELHF growth, cycling and pigmentation and to probe novel strategies for the therapeutic and cosmetic manipulation of ELHFs beyond prostaglandin receptor stimulation.

Oral manifestations of HIV/AIDS in Asia: Systematic review and future research guidelines

Objectives

The authors have conducted a systematic review of oral manifestations of HIV from studies conducted in Asia to establish the characteristics and prevalence of individual oral manifestations in Asia, and to assess the direction of future research studies on oral manifestations of HIV in Asia.

Material and Methods

The electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE], EBSCO, and EMBASE. The search was for limited articles published in English or with an English abstract and articles published during the period January 1995 to August 2014. The authors reached a final overall sample of 39 studies that were conducted in Asia.

Results

The median population size among all studies was 312.7 patients. Oral candidiasis [OC] was the most common oral manifestation [37.7%] in studies conducted in Asia. The overall prevalence of oral hairy leukoplakia and melanotic hyperpigmentation was computed to be 10.1% and 22.8% respectively. Thailand and India are primarily countries with maximum research on oral manifestations.

Conclusions

The research on oral manifestations of HIV in Asia has to upgrade to more interventional and therapeutic studies rather than the contemporary cross- sectional epidemiological descriptive studies. The authors have given suggestions and future directions for the implementation of clinical research of oral manifestations in HIV patients.

Key words:Oral manifestations, HIV/AIDS, Asia, Systematic review.

Frequency, pattern, and extent of skin diseases in relation to CD4+ cell count among adults with human immunodeficiency virus infection or acquired immunodeficiency syndrome in Osogbo, southwestern Nigeria

BACKGROUND

Skin diseases characterize all stages of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and contribute significantly to associated morbidity and mortality.

OBJECTIVES

The aim of this study was to document the prevalences, patterns, and extents (severity) of skin diseases and their relationships with immunologic status in HIV/AIDS patients.

METHODS

A total of 140 HIV/AIDS patients in different stages of HIV infection and 140 controls were recruited. Skin diseases were documented and CD4+ cell counts determined in all subjects. Severity was assessed according to the body surface area affected (using the Wallace rule of nines and the rule of palm) for lesions that tended to be widespread. The number of digits involved was counted for lesions involving the nails. Intensity of pain was graded for specific conditions such as herpes zoster. Chi-squared statistics and Pearson correlations were determined.

RESULTS

Mean±standard deviation age was 35.04±8.83 years in the patient group and 32.21±8.30 years in the control group. The prevalences and patterns of skin diseases in HIV/AIDS patients were similar to those reported in previous studies. Most commonly found dermatoses were oral candidiasis (n=28, 20.0%), pruritic papular eruption (n=27, 19.3%), xeroderma (n=23, 16.4%), dermatophytosis (n=22, 15.7%), and fluffy hair (n=19, 13.6%). The presence of specific skin lesions represented a better correlate with immunosuppression than cutaneous extents. However, the extents of viral warts and multiple blue–black nails correlated significantly with CD4+ cell count. The presence of a lighter hair color phenotype signifies a lower CD4+ cell count than a softer hair phenotype.

CONCLUSIONS

The presence of specific skin lesions correlates more strongly with a low CD4+ cell count than does the extent of their distribution, except in cases of viral warts. The presence of and higher numbers of nails affected with blue–black nail hyperpigmentation suggest severe immunosuppression.

Defective IL-17- and IL-22-dependent mucosal host response to Candida albicans determines susceptibility to oral candidiasis in mice expressing the HIV-1 transgene

BACKGROUND

The tissue-signaling cytokines IL-17 and IL-22 are critical to host defense against oral Candida albicans infection, by their induction of oral antimicrobial peptide expression and recruitment of neutrophils. Mucosal Th17 cells which produce these cytokines are preferentially depleted in HIV-infected patients. Here, we tested the hypothesis that defective IL-17- and IL-22-dependent host responses to C. albicans determine the phenotype of susceptibility to oropharyngeal candidiasis (OPC) in transgenic (Tg) mice expressing HIV-1.

RESULTS

Naïve CD4+ T-cells and the differentiated Th1, Th2, Th17, Th1Th17 and Treg lineages were all profoundly depleted in cervical lymph nodes (CLNs) of these Tg mice. However, naive CD4+ cells from Tg mice maintained the capacity to differentiate into these lineages in response to polarizing cytokines in vitro. Expression of Il17, Il22, S100a8 and Ccl20 was enhanced in oral mucosal tissue of non-Tg, but not of Tg mice, after oral infection with C. albicans. Treatment of infected Tg mice with the combination of IL-17 and IL-22, but not IL-17 or Il-22 alone, significantly reduced oral burdens of C. albicans and abundance of Candida hyphae in the epithelium of tongues of infected Tg mice, and restored the ability of the Tg mice to up-regulate expression of S100a8 and Ccl20 in response to C. albicans infection.

CONCLUSIONS

These findings demonstrate that defective IL-17- and IL-22-dependent induction of innate mucosal immunity to C. albicans is central to the phenotype of susceptibility to OPC in these HIV transgenic mice.

Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count

In this study, 100 HIV-positive cases (63 men, 37 women) with skin findings were included. The mean CD4 T cell count was 253 cells/mm(3). 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 seborrhoeic 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.

The impact of human immunodeficiency virus-related diseases on pigmented skin types

Infection with human immunodeficiency virus (HIV) remains a significant problem globally. Early diagnosis and treatment with antiretroviral drugs has considerably improved health outcomes and decreased disease-related morbidity. HIV infection is associated with a wide range of skin disorders enabling dermatologists to diagnose HIV as well as associated opportunistic infections early in the course of disease. Despite concerted efforts by international health organizations to limit disease incidence, the prevalence of HIV infection remains high and is highest in sub-Saharan Africa. The diagnosis of HIV-related skin diseases is challenging as immunosuppression often results in atypical disease presentation. In addition, the clinical presentation will vary in pigmented skin types. The aim of this article is to describe disease variation in pigmented skin types.

Skin and Mucocutaneous Manifestations: Useful Clinical Predictors of HIV/AIDS

BACKGROUND AND AIMS

The HIV infection is associated with several dermatological conditions which may be the first pointer towards the existence of HIV. These may present with unusual and atypical manifestations in the course of the HIV infection. Keeping this in mind, the seroprevalence of HIV in these persons and the spectrum of the skin and the mucocutaneous lesions in the HIV positive patients was studied.

METHODS

The current prospective study was conducted over a period of 3 years (2006-2008). A total of 604 persons who had any kind of skin and mucocutaneous infections were screened for the HIV infection as per the NACO guidelines after recording their clinical and epidemiological profiles.

RESULTS

Out of the 604 patients who were screened, 90(14.90%) were seropositive for the HIV-I antibodies and none was positive for the HIV-2 antibodies. Seventy three point thirty three percent 73.33 of the seropositive patients were in the age group of 15-40 years, with a male-female ratio of 1:1.05. The heterosexual route was the most common mode of transmission (86.6%).A wide range of infectious and noninfectious lesions were observed. In the HIV seropositive patients, oral candidiasis (32.22%) was the most common infectious disease which was observed, followed by herpes zoster (13.33%), genital warts (7.77%) and genital herpes (6.66%). The most common noninfectious manifestation was seborrhoic dermatitis (8.88%), followed by pruritic papular eruptions (7.77%).

CONCLUSION

As there is a high prevalence of the HIV infection in patients who have skin and mucocutaneous disorders, the doctors, during the investigation of these patients, must have a high level of suspicion for the HIV infection in their mind. An early detection of HIV optimizes the chemoprophylaxis for many opportunistic mucocutaneous disorders.

Oral manifestations of human immunodeficiency virus in children: An institutional study at highly active antiretroviral therapy centre in India

CONTEXT

More than 1000 children are newly infected with Human immunodefi ciency virus (HIV) every day, and of these more than half will die as a result of AIDS due to lack of access to HIV treatment. HIV disease varies considerably in children. Among those infected prenatally, some experience few or no symptoms for years, whereas in others the disease progresses rapidly. The risk factors that influence the development of such oral manifestations include, low CD4+ T cell count, xerostomia and lack of highly active antiretroviral therapy (HAART).

AIMS

To identify the oral manifestations of HIV in children receiving HAART.

MATERIALS AND METHODS

The study comprised 95 children receiving HAART. 95 HIV +ve children not receiving HAART and 95 HIV -ve children were also included for comparing the manifestations of HIV.

STATISTICAL ANALYSIS USED

Statistical analysis was done using Fisher's Chi-square test. Probability value (P value) was obtained for the three groups.

RESULTS

The manifestations of HIV that were observed in children receiving HAART include dental caries (26%), periodontal diseases (23%), candidiasis (19%), hyperpigmentation (17%), ulcerative stomatitis (9%) and one case of mucocele. These manifestations were compared with HIV +ve children not receiving HAART and HIV -ve children to find manifestations with statistical significance.

CONCLUSIONS

We conclude that HAART had increased the disease-free states in HIV +ve children on HAART promising them better life span. The incidence of oral lesions can further come down with adequate oral hygiene measures in HIV-infected children.

Scalp seborrheic dermatitis: prevalence and associated factors in male adolescents

BACKGROUND

The prevalence of seborrheic dermatitis (SD) in the general population is variable in the literature. Factors associated with SD are not well understood.

OBJECTIVE

To verify the prevalence of scalp SD in a selected survey of male adolescents on mandatory military service and to find possible associated factors (skin color, socioeconomic level, triceps skin fold, acne, and tobacco consumption).

METHODS

This cross-sectional study included 18-year-old male adolescents on compulsory military service in a southern Brazilian city. Scalp SD was considered as erythema and scaling in any part of the scalp. Skin color, socioeconomic level, triceps skin fold, acne, and tabagism comprised the independent variables studied in our population.

RESULTS

A total of 2201 adolescents entered the study. The global prevalence of scalp SD was 11%. White skin [adjusted prevalence ratio (PR) 1.42; 95% CI 1.06-1.92; P = 0.02] and triceps skin fold >19.5 mm (adjusted PR 1.56; 95% CI 1.12-2.18; P = 0.009) were significantly associated with scalp SD. The other variables were not associated with the outcome.

CONCLUSIONS

Prevalence of scalp SD in our survey of male adolescents was 11%. The occurrence of scalp SD was associated with white skin and a higher body fat content.

Oral Manifestations Related To CD4 Lymphocyte Count in HIV-Positive Patients

Background and aims

The onset of opportunistic infections in HIV-positive patients is generally associated with a low CD4 count. Oral manifestations can be the first clinical sign of the infection and also determine the progression of disease. The purpose of this study was to determine the prevalence of oral soft tissue manifestations and their relationship with the degree of immunosuppression observed in HIV-positive patients.

Materials and methods

100 HIV-positive patients were examined. Oral lesions were evaluated according to EEC clearing house criteria. The degree of immunosuppression was based on the CD4 count closest to the oral examination. Data were analyzed using Student’s t-test and chi-square test.

Results

The most common oral lesions were rampant caries (54%), periodontal disease (44%), and hyperpigmentation (42%). Salivary glands enlargements and leukoplakia were associated with more severe immunosuppression.

Conclusion

According to the results, it seems that occurrence of only some of oral lesions are related to the degree of immunosuppression and such lesions can be considered as indicators of the progression of the HIV infection.

Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults

OBJECTIVES

To evaluate the use of grey/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings.

METHODS

We tested whether grey/distal banded nails and/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut-offs: <200 and <350 cells/microl in ART naive adults.

RESULTS

Four hundred and three nail and oral cavities were photographed and assessed. Grey/distal banded nails and/or oral pigmentation were significantly associated with a CD4 cell count <200 cells/microl (P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut-off of <350 cells/microl was used. Inter-observer agreement (k 0.46) was fair/moderate.

CONCLUSIONS

While grey/distal banded nails and/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed.