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Sivaz O, Ozkur E, Altunay IK, Oncul A, Sevgi DY. Mucocutaneous Manifestations of People Living with HIV in Current Antiretroviral Therapy Era. Curr HIV Res 2022; 20:120-128. [PMID: 35236269 DOI: 10.2174/1570162x20666220302141504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/04/2022] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Onur Sivaz
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ezgi Ozkur
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ilknur Kivanc Altunay
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ahsen Oncul
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
| | - Dilek Yıldız Sevgi
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
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Widaty S, Oktarina C, Suling PL, Niode NJ, Miranda E, Andriani A, Amin S, Yenny SW, Bramono K. Mucocutaneous mycoses in people living with human immunodeficiency virus in Indonesia. Mycoses 2021; 65:323-330. [PMID: 34902221 DOI: 10.1111/myc.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To date, integrated care for people living with human immunodeficiency virus (PLHIV) has improved. However, although the management of mucocutaneous mycosis cases has improved, disease progression might be different in immunocompromised patients, which leads to variable clinical manifestations. OBJECTIVES To describe the characteristics of mucocutaneous mycosis cases in the PLHIV population and its associated factors in Indonesia. METHODS This retrospective study was conducted from January 2014 to December 2018 in four academic hospitals. Data were acquired from medical records with the inclusion of mucocutaneous mycosis patients with concurrent HIV infection. Analysis with the chi-squared test was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. RESULTS A total of 1,796 cases of mucocutaneous mycoses were identified in 1782 PLHIV. The most common types of infection were candidiasis (63%), followed by dermatophytosis (35.1%), and malasseziosis (1.9%), which were significantly higher in PLHIV with CD4 level <200 cells/mm3 . The proportions of male gender (78.6% vs. 56.3%, p < .001), high level of education (48.0% vs. 64.1%, p < .001), office workers (73.8% vs. 64.1%, p < .001), combination of topical and systemic antifungal agents (59.1% vs. 48.5%, p = .006) and not receiving antiretroviral therapy (63.2% vs. 7.8%, p < .001) were significantly higher in PLHIV with a CD4 level <200 cells/mm3 . CONCLUSION In Indonesia, the most common fungal infection in PLHIV is candidiasis. This study also addressed the important matters regarding mucocutaneous mycoses in PLHIV. Education is an important measure to prevent the incidence of cutaneous mycoses in PLHIV, especially in high-risk groups.
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Affiliation(s)
- Sandra Widaty
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Caroline Oktarina
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Pieter Levinus Suling
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Universitas Samratulangi - Prof. Dr. Kandou General Hospital, R. W. Monginsidi (Malalayang), Manado, Indonesia
| | - Nurdjannah Jane Niode
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Universitas Samratulangi - Prof. Dr. Kandou General Hospital, R. W. Monginsidi (Malalayang), Manado, Indonesia
| | - Eliza Miranda
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Anni Andriani
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University - dr. Wahidin Sudirohuosodo General Hospital, Makassar, Indonesia
| | - Safruddin Amin
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University - dr. Wahidin Sudirohuosodo General Hospital, Makassar, Indonesia
| | - Satya Widya Yenny
- Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia.,Department of Dermatology and Venereology, Faculty of Medicine, Andalas University - M. Djamil General Hospital, Perintis Kemerdekaan, Padang, Indonesia
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - dr. Cipto Mangunkusumo National Central General Hospital, Central Jakarta, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
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Mirnezami M, Zarinfar N, Sofian M, Botlani Yadegar B, Rahimi H. Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4 Lymphocyte Counts. SCIENTIFICA 2020; 2020:7503756. [PMID: 32850174 PMCID: PMC7439183 DOI: 10.1155/2020/7503756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/01/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Mina Mirnezami
- Department of Dermatology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Nader Zarinfar
- Department of Infectious Diseases, Arak University of Medical Sciences, Arak, Iran
| | - Masoomeh Sofian
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hoda Rahimi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Davarpanah MA, Motazedian N, Jowkar F. Dermatological Manifestations of HIV/AIDS Individuals in Shiraz, South of Iran. J Glob Infect Dis 2018; 10:80-83. [PMID: 29910568 PMCID: PMC5987376 DOI: 10.4103/0974-777x.233000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction HIV infection remains as a major challenge facing medical sciences in the world today. Mucocutaneous manifestation was first observed in patients with HIV/AIDS in the early 1980s. The aim of this study was to identify various skin manifestations based on making careful clinical observations and performing the necessary tests. Materials and Methods A total of 240 patients whose disease was diagnosed using WB and ELISA tests, with dermatologic manifestations and were older than 18 years, participated in this study. These patients had referred to the voluntary counseling and testing center in Shiraz for routine examinations. Results From the total of 240 participants, 158 were males (65.8%) and 82 were females (34.2%). The mean age was 40.87 ± 8.04 years. Dermatologic manifestations were of infectious origin in 79 (33%) of the participants. As the most common viral skin infections, herpes simplex was seen in 16 patients (6.7%), with herpes zoster ranking second with 15 patients (6.3%). No relationship was found between CD4 cell count and infectious or noninfectious dermatologic manifestations (P = 0.274). Conclusion No association was found between CD4 cell counts and dermatologic manifestations. Many skin disorders may appear in HIV/AIDS patients with normal CD4 cell counts.
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Affiliation(s)
| | - Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farideh Jowkar
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Chandrakala C, Parimalam K, Wahab AJ, Anand N. Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study. Indian J Sex Transm Dis AIDS 2017; 38:128-135. [PMID: 30148265 PMCID: PMC6085934 DOI: 10.4103/ijstd.ijstd_130_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered. Aim: This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients. Materials and Methods: A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, <50, 50–200, 201–500, >500, respectively. Results: The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count < 50. Majority of the infectious and non-infectious dermatoses were common in the CD4 count between 201–500 (Group III) and 50–200 (Group II). In the study groups, 52 cases (52%) were on antiretroviral therapy (ART), and the remaining 48 cases (48%) were not on ART at the time of diagnosis of mucocutaneous manifestations. Out of 48 ART-naïve cases, 23 patients were screened and newly diagnosed at the outpatient department (OPD) based on the mucocutaneous manifestations. Most of the patients with multiple mucocutaneous conditions were in the CD4 count <200, whereas single manifestation was seen predominantly in CD4 count >200. Conclusion: Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.
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Affiliation(s)
- C Chandrakala
- Department of Dermatovenereology, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
| | - K Parimalam
- Department of Dermatovenereology, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
| | - Afthab Jameela Wahab
- Department of Dermatovenereology, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
| | - N Anand
- Department of Community Medicine, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
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Bhari N, Pahadiya P, Arava S, Gupta S. Histoplasmosis mimicking non-Hodgkin lymphoma in a 40-year-old man with AIDS. Int J STD AIDS 2016; 28:312-314. [PMID: 27535728 DOI: 10.1177/0956462416665942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In patients with acquired immunodeficiency syndrome (AIDS), advanced immunosuppression is associated with atypical presentation of dermatological conditions. Our patient presented with a single crusted plaque over the lower lip and large tender cervical lymphadenopathy. The enzyme-linked immunosorbent assay for human immunodeficiency virus was found to be positive, and his CD4+ lymphocyte cell count was 4 cells/mm3. The presence of multiple histoplasma spores in the biopsies from the crusted plaque over lip and cervical lymph node helped in the confirmation of the diagnosis of histoplasmosis, and the patient showed significant improvement within two months of treatment with conventional injection amphotericin B initially followed by oral itraconazole.
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Affiliation(s)
- Neetu Bhari
- 1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Pahadiya
- 1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- 2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- 1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Padovese V, Racalbuto V, Barnabas GA, Morrone A. Operational research on the correlation between skin diseases and HIV infection in Tigray region, Ethiopia. Int J Dermatol 2016; 54:1169-74. [PMID: 26394603 DOI: 10.1111/ijd.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/27/2014] [Accepted: 07/08/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Ethiopia, skin diseases are among the leading causes of outpatient attendance to primary health service. Correlation of skin diseases and HIV has long been recognized and used to guide medical management in resource-limited settings. Therefore, this study aims to assess the correlation of skin diseases and HIV infection, to estimate epidemiological distribution in the study area, and to provide health workers of skin indicators for HIV early detection. METHODS The operational research was designed as a case-control study and carried out in three intervention districts of Tigray region; baseline and final data on skin diseases and HIV were compared with those of three control districts matched for population size, density, and environmental characteristics. Health workers of intervention districts were trained on skin diseases/STIs diagnosis and treatment. Data were collected from study and control districts and then analyzed at the Italian Dermatological Centre (IDC) in Mekele. RESULTS In the research period, a total of 1044 HIV positive patients were detected. Disorders of skin and mucous membranes statistically related with HIV (P < 0.05) were tongue papillary atrophy (80%), oral hairy leukoplakia (69%), herpes zoster (66%), oral candidiasis (50%), pruritic papular eruption (43%), condylomata acuminata (38%), and telogen effluvium (27%). CONCLUSIONS The high frequency of oral disorders and telogen effluvium is not described in literature and may be indicative for case detection. Operational research offers significant gains on health service delivery and outcomes at relatively low cost and in a short timeframe.
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Affiliation(s)
- Valeska Padovese
- National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy
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A CLINICAL OBSERVATIONAL STUDY OF OROCUTANEOUS MANIFESTATIONS IN PEOPLE LIVING WITH HIV/AIDS. ACTA ACUST UNITED AC 2016. [DOI: 10.14260/jemds/2016/479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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