Morphological spectrum of cutaneous manifestations with CD4 correlation in patients with AIDS
Keywords:
Antiretroviral therapy, CD4 cell count, Human Immunodeficiency Virus infection, Mucocutaneous manifestationsAbstract
Background: Human Immunodeficiency Virus (HIV) infection is a major challenge in the world today. More than 90% of HIV-infected patients are affected by mucocutaneous complaints during the course of their disease. It produces a wide range of infectious and noninfectious dermatoses, which correlate with the degree of immunodeficiency. Even after the introduction of antiretroviral therapy, the visible impact of skin lesions remains a major area of concern in patients living with HIV, affecting their quality of life and self-esteem. Objective: To determine the pattern of cutaneous manifestations in patients with AIDS and to correlate with CD4 counts. Materials and methods: This cross sectional study was conducted on 300 HIV seropositive patients attending the Dermatology outpatient department and HIV clinic of Services Hospital, Lahore over a period of 1year (June 2017- May 2018). Out of 300 patients, 290 were on ART. After informed consent a thorough clinical examination of skin was performed. The most recent CD4 counts (cells/mm3) of patients obtained from medical record. All the mucocutaneous conditions of the patients were noted and categorized as infectious, noninfectious dermatoses and drug reactions. The patients were classified into different stages according to the World Health Organization clinical and immunological staging system. SPSS v. 22 was used for data entry and analysis. Results: Out of 300 HIV seropositive patients 228 (76.0%) were males and 72 (24%) were females with a gender ratio of 3:1. The mean age of patients was 33.67 ± 10.84 years. Heterosexual route of transmission was the commonest route 96(32%), followed by blood transfusion 84 (28%), surgical procedure 72 (24%), intravenous drug abuse 44 (14.7%) and sharing of common needle or injection 20 (6.7%).The mean duration of HIV was 1.49 ± 0.77 years. Number of dermatoses per patient increased as the CD4 count decreased. Proportion of patients having dermatoses increased with immunological worsening; 8% of patients with CD4 count >500 compared with 77.3% of patients with CD4 count of 200-350.The most prevalent infection was dermatophytosis, seen in 60 patients with a mean CD4 count of 165.6±10.2 followed by candidiasis 40 patients with CD4 count of 220 ±179.1. Xerosis was the most common non-infectious disorder. Conclusion: Mucocutaneous manifestations occur throughout the course of HIV infection. Dermatoses like dermatophytosis and molluscum contagiosum show an inverse relation with CD4 cell count, and these dermatoses can be used as a proxy indicator of advanced immunosuppression in the absence of facilities to carry out CD4 cell count. Keywords: Antiretroviral therapy, CD4 cell count, Human Immunodeficiency Virus infection, mucocutaneous manifestations.References
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