Clinical study on Dermatological Presentation in 100 cases of HIV Infection

Lincy, C F (2011) Clinical study on Dermatological Presentation in 100 cases of HIV Infection. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Acquired immunodeficiency syndrome (AIDS) was recognized as a new disease for the first time in 1981. AIDS was recognized because in March 1981 eight cases of more aggressive form of Kaposi’s Sarcoma had occurred amongst young gay men in New York and at the same time there was an increase in the number of cases of Pneumocystis Carinii pneumonia (PCP) in both California and New York. Despite the development of laboratory methods, dermatological symptoms were in the past and still are the basic indicators of presence and physical course of the disease; human immunodeficiency virus (HIV) infection and AIDS are frequently related to a wide range of skin and mucosal manifestations. This ranges from macular, roseola like rash in the acute seroconversion syndrome to the extensive end-stage Kaposi’s Sarcoma. In primary HIV infection manifestations like fever, joint pain and night sweats are non specific for identifying acute seroconversion, because in developing countries where other endemic diseases with similar complaints are common. In the developed countries, primary HIV-1 infection is estimated to be symptomatic in up to 80% of cases [Acute retroviral syndrome (ARS)] with the advent of Highly Active Anti Retroviral Therapy, the course of HIV/AIDS has been significantly changed. In this study an attempt is made to find out the various dermatological manifestations associated with HIV/AIDS and to identify the most common predictor of HIV/AIDS in this part of the country. AIM OF THE STUDY 1. To collect data and analyze the dermatological presentations in HIV patients. 2. If the patients were on antiretroviral therapy to assess the frequency of specific dermatological diseases or adverse reactions to antiretroviral drugs. 3. To assess the common dermatological diseases in HIV patients. 4. To correlate the CD4+ count at which usually each dermatological disease will occur. MATERIALS AND METHODS : The study was conducted in Department of Dermatology, Venereology and Leprology, Coimbatore Medical College Hospital during the period May2009 to April 2010. All the patients attending the Dermatology outpatient department at Coimbatore Medical College Hospital were screened and HIV patients with Mucocutaneous manifestations were enrolled. INCLUSION CRITERIA : All HIV patients attending the Skin and Venereology Department in Coimbatore medical college, age in between 18-55 years. EXCLUSION CRITERIA : 1. Patients less than 18 years and more than 55 years. 2. Pregnant woman. All the HIV patients with mucocutaneous manifestations were enrolled in a chronological order. For each patient name, age, sex, address, occupation and income etc noted. Complaints, duration, history of recurrences, history suggestive of risk to sexually transmitted infections, past history, family history and treatment history were also noted. A thorough examination of both general and systemic carried out. Dermatological examination including the number, site, morphology and distribution of primary and secondary lesions then examination of oral and genital mucosa, scalp, hair, nail, palms and soles carried out. Based on this patients were classified as having infective, inflammatory, neoplastic and other diseases. Investigations like haemogram, blood sugar, blood VDRL, liver function test, urine examination, Mantoux test and CD4 count were done in all cases. Scraping for fungus, appropriate staining and biopsy were done in relevant cases. All the patients were given symptomatic treatment. Details thus obtained were compiled, tabulated and statistically summarized. CONCLUSION : HIV/AIDS involves almost all the organs in the body. Mostly Infections and Malignancies are seen. Many a time the evolution of the cutaneous manifestation gives a clue to the diagnosis of HIV and stage of the disease. At times depending upon the CD4+ count, there is specific dermatological manifestations. Mostly cutaneous manifestations are clear markers of HIV disease, and many a time they may be the first lesion to be identified in an otherwise normal HIV reactive patient. In the present study we have attempted to identify the common cutaneous markers of HIV/AIDS and we have found out that indeed there is a correlation between certain dermatological conditions and HIV spectrum. Various previous studies and our study are correlating each other. Most common presentation in our study is Pruritic Papular Eruption (24%). Then Herpes Zoster (13%), Herpes simplex (8%), Dermatophytosis (8%) and Candidiasis (7%) was observed. Incidence of Candidiasis was probably low because patients were coming in the earlier stage or had taken symptomatic treatment from outside. To conclude cutaneous manifestations are the most common presentation of HIV disease and Pruritic Papular Eruption, and Herpes Zoster are the tell tale evidences of HIV disease.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical study ; dermatological presentation ; 100 cases ; HIV infection.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 09:26
Last Modified: 03 Mar 2018 05:11

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