[Survival in HIV-1 patients receiving antiretroviral therapy in Morocco]

BACKGROUND

The purpose was to study factors associated with the survival of HIV-1 patients receiving antiretroviral therapy in Morocco.

MATERIAL AND METHOD

This was a retrospective study of a cohort of 182 HIV-1 patients receiving antiretroviral therapy in the department of dermatology venereology at the Military Instruction Hospital Mohamed V in Rabat during the period from 1 January 2006 to 1 January 2017. Death of any cause during the study period was considered to be the result of HIV infection. The log-rank test was used to compare the survival curves based on determinants. The Cox regression model analyzed the determinants of survival since induction of antiretroviral therapy.

RESULTS

The median follow-up time was 4.7 years (IQR: 1.97-8.18). The mortality rate was 75 deaths per 1000 person-years. Advanced clinical stage CDC C (RR: 2.72; CI 95%: 1.33-5.56) and treatment with indinavir (RR: 1.41; CI 95%: 0.77-2.59) were significantly associated with death.

CONCLUSION

Initiation of antiretroviral therapy in the early stage of the disease and use of less toxic molecules are recommended to reduce mortality.

[Cutaneous cryptococcosis mimicking basal cell carcinoma and revealing systemic involvement in acquired immunodeficiency]

BACKGROUND

Cryptococcosis is a rare and a serious opportunistic infection that occurs primarily on the field of immunodeficiency. We report a case of disseminated cryptococcosis in acquired immunodeficiency syndrome revealed by unusual skin lesions.

OBSERVATION

A 52-year-old patient consulted for two crusty ulcerative lesions situated on the left supraorbital and on the nasal tip that appeared 6 months ago. He also reported respiratory symptoms present since one year, with dry cough and dyspnea, chronic headache and vomiting with no alteration in visual acuity. The mycological study of the skin biopsy on both lesions isolated Cryptococcus neoformans as well as in the sputum and cerebrospinal fluid. Serology of human immunodeficiency virus infection was positive. Treatment with fluconazole, local care and antiretroviral triple therapy was implemented.

DISCUSSION

Skin lesions during cryptococcosis are rare and observed in 2-10% of cases. Cutaneous symptoms were the reason for consultation in our patient. This is a rare form of cutaneous cryptococcosis leading to the discovery of both pulmonary and central nervous system locations, and to diagnosis of HIV infection.