Morphological spectrum of cutaneous manifestations with CD4 correlation in patients with AIDS
DOI:
https://doi.org/10.66344/jpad.v33i3.2255Keywords:
Antiretroviral therapy, CD4 cell count, Human Immunodeficiency Virus infection, Mucocutaneous manifestationsAbstract
Objective To determine the frequency and spectrum of cutaneous manifestations in patients with AIDS and their relationship to CD4 counts.
Methods 300 HIV seropositive patients who visited the Dermatology outpatient department and HIV clinic of Services Hospital, Lahore over a period of 1year (June 2017- May 2018) were included in this cross sectional study. Out of 300 patients, 290 were on ART. Thorough cutaneous examination was performed after informed consent. CD4 counts (cells/mm3) of the patients noted from medical record. All the mucocutaneous conditions of the patients were noted and categorized as infectious, noninfectious dermatoses and drug reactions. Clinical and immunological staging method developed by World Health Organization (WHO) was used to classify patients into different stages. Data analysis was carried out using SPSS V.22.
Results Among the 300 HIV-positive individuals, a gender ratio of 3:1 was observed with 228 (76.0%) men and 72 (24%) women. Patients’ average age 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. There were more dermatoses per subject as the CD4 count dropped. Immunological deterioration lead to increase in the number of patients having dermatoses; 8% patients with CD4 count of >500 compared to 77.3% patients with CD4 count of 200-350. Dermatophytosis was the most common infection, 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 develop during the course of HIV infection. Dermatophytosis and candidiasis exhibit a significant reciprocal relationship with CD4 cell count, and because of this they can be utilised as an indirect evidence of severe immunosuppression to initiate highly active anti-retroviral therapy in the absence of access to resources for CD4 cell count.
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