Title: Study of Mucocutaneous Involvement in HIV in a Tertiary Care Centre

Authors: Julie Leishangthem, Ranjeeta Sapam, Oinam Gyanpati Devi

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.160

Abstract

Background: Cutaneous manifestations are common among HIV infected persons. Certain characteristic skin changes can help clinicians to recognize previously undiagnosed HIV infection.

Aims and Objectives: To determine the clinical pattern and prevalence of various mucocutaneous manifestations in HIV infected patients.

Materials and Methods: A retrospective one year study was done which included all HIV infected patients attending Dermatology OPD, J.N.I.M.S., Imphal from January 2015 to December 2015. Cutaneous findings among the patients were recorded and evaluated.

Results: The total number of patients infected with HIV attending the dermatology OPD during the study period was 146, out of which 88 (60.3%) were males and 58 (39.7%) were females. A total of 92 patients (63%) were found to have mucocutaneous manifestations out of which 48 (52.2%) were males and 44 (41.8%) were females. The age group most commonly involved was 31-45 years (41.8%). Pruritic papular eruption (21.7%) was the most common skin involvement. The most common infections seen were candidiasis (17.4%), dermatophytosis (7.6%), herpes zoster (5.4%), human papilloma virus infection (3.3%),herpes simplex virus infection (3.3%), folliculitis (3.3%) and chancroid (3.3%). Seborrheic dermatitis (6.5%), maculopapular drug rash (4.3%), generalized pruritus (3.3%)were common non-infectious conditions seen. Penicilliosis (5.4%) was also seen.

Conclusion: Mucocutaneous involvement occurs in every stage of HIV and awareness of the varied pattern of these manifestations would help in the early diagnosis and management of HIV infection, thereby decreasing the morbidity and improve the quality of life in them.

References

  1. Valle SL, Saxinger C, Ranki A, Antonen J, Suni J, Lähdevirta J, et al. Diversity of clinical spectrum of HTLV-III infection. Lancet 1985; 1: 301–304.
  2. Kumarswamy N, Sunti S, Madhivanan P, Ravikumar B, 2. Thyagarajan SP, Yesudian P. Dermatologic manifestations among immunodeficiency virus patients in South India. Int J Dermatol 2000; 39: 192–195.
  3. Tzung TY, Yang CY, Chao SC, Lee JY. Cutaneous mani-3. festations of human immunodeficiency virus infection in Taiwan. Kaohsiung J Med Sci 2004; 20: 216–224.
  4. Muñoz-Pérez MA, Rodriguez-Pichardo A, Camacho F, 4. Colmenero MA. Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predomi-nantly acquired through intravenous drug abuse. Br J Dermatol 1998; 139: 33–39.
  5. Raju PV, Rao GR, Ramani TV, Vandana S. Skin disease: clini-14. cal indicator of immune status in human immunodeficiency virus (HIV) infection. Int J Dermatol 2005; 44: 646–649.
  6. Nnoruka EN, Chukwuka JC, Anisuiba B. Correlation of mucocutaneous manifestations of HIV/AIDS infection with CD4 counts and disease progression. Int J Dermatol 2007; 46 Suppl 2: 14–18.
  7. Sailo L et al. Int J Res Dermatol. 2017 Dec;3(4):506-511
  8. Siriyathorn A, Srihra B, Leesanguankul W. Prevalence of skin diseases in patients infected with human immunodeficiency virus in Bangkok, Thailand. Ann Acad Med Singapore 1995; 24: 529-33.
  9. Calabrese L, Proffitt MR, Levin KH. Yen-Lieberman B, Starkey C. Acute infection with the humanimmunodeficiency virus (HIV) associated with brachial neuritis and xanthematous rash. Ann Intern Med 1987; 107: 849-51.
  10. Johnson RA, Dover JS. Cutaneous manifestation of human immunodeficiency virus disease. In : Fitizpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austin KF, eds. Dermatology in General Medicine. 4th ed. New York: Mc Graw-Hill, 1993: 2637-89
  11. Tschachler E, Bergstresser PR, Stingl G. HIV-related skin disease. Lancet 1996; 348: 659-93
  12. Annual report: NACO; 2014-15. HIV estimation. 2015
  13. Joge US, Deo DS, Lakde RN, Choudhari SG, Malkar VR and Ughade HH. Socio demographic and clinical profile of HIV/AIDS patients visiting to ART Centre at a rural tertiary care hospital in Maharashtra state of India. Int J Biol Med Res. 2012;3(2):1568-72
  14. Zaheer MS, Rabbani MU, Zuber Ahmed, Tamkin Khan, Rewari BB, Pandey DK. Clinical and demographic profile of patients of AIDS in and around Aligarh. JIACM. 2003; 4(2):121-26
  15. Nayak UB, Lenka S. Clinical and Socio demographic profile of attendees at ART centre in a tertiary care hospital in Mangalore, India. Asian Journal of Medical Sciences. 2015;6:5.
  16. HIV and AIDS statistics commentary. UNAIDS/ WHO AIDS epidemic update, November 2007. Available at http://www.org
  17. Wiwanitkit V. Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: A note on 120 cases. Int J Dermatol. 2004;43:265-
  18. Shobhana A, Guha SK, Neogi DK. Mucocutaneous manifestations of HIV infection. Indian J Dermatol Venereol Leprol. 2004;70:82-6
  19. Mythili Chandrasekaran. " Dermato-logical Manifestations of Hiv - Study of 100 Cases." IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 16.8 (2017): 22-25
  20. Tzung TY, Yang CY, Chao SC, Lee JY. Cutaneous manifestations of human immunodeficiency virus infection in Taiwan. Kaohsiung J Med Sci 2004; 20: 216–224
  21. Kullavanijaya P, Bisalbutra P. Frequency distribution of skin diseases in HIV infected patients (1991-1995) Institute of Dermatology, MOPH, Bangkok, Thailand. Dematology 2000. Bangkok: Holistic Publishing. 1997: 513
  22. Lakshmi S J, Rao G R, Ramalakshmi, Satyasree, Rao K A, Prasad P G, Kumar Y H. Pruritic papular eruptions of HIV: A clinicopathologic and therapeutic study. Indian J DermatolVenereolLeprol [serial online] 2008 [cited 2018 Jun 11];74:501-3
  23. Goldstein B, Berman B, Sukenik E, Frankel SJ. Correlation of skin disorder with CD4 lymphocyte counts in patients with HIV/AIDS. J Am AcadDermatol 1997; 36: 262-4
  24. Supanaranond, V. Desakorn, C. Sitakalin, N.Ngaing, P.Chirachankul. Cutaneous manifestations in HIV positive patients.Southeast Asian J Trop Med Public Health 2001 Mar;32(1):171-6
  25. Swamiappan M, Chandran V, Ramasamy S, et al. Pattern of mucocutaneous manifestations of HIV infected patients: a retrospective study. J. Evolution Med. Dent. Sci. 2016;5(59):4060-4063
  26. Sivayathorn A, Sriha B, Leesanguankul W. The spectrum of mucocutaneous manifestations during the evolutionary phases of HIV diseases: an emerging Indian scenario. J Dermatol. 1999;26 (5):194-302
  27. Nissapatorn V. Lessons Learned About Opportunistic Infections in Southeast Asia. Southeast Asian J Trop Med Public Health. 2008;39:625-41
  28. Chiewchannvit S, Wongmaneerojn T. Prevalence of cutaneous disease in HIV- infected patients at MaharajNakhon Chiang Mai Hospital, Thai J Dermatol 1993; 3: 205-13
  29. Munoz-Perez MA, Rodriguez-Pichardo A, Camacho F, et al. Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse. Br J Dermatol 1998;139(1):33-9
  30. Singh H, Singh P, Tiwari P, et al. Dermatological manifestations in HIV-infected patients at a tertiary care hospital in a tribal (Bastar) region of Chhattisgarh, India. Indian J Dermatol 2009;54(4):338-41
  31. Sharma YK, Sawhney MPS, Bhakuni DS, et al. Orocutaneous manifestations as markers of disease progression in HIV infection in Indian setting. MJAFI 2004;60(3):239-43

Corresponding Author

Ranjeeta Sapam

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 9436891550