Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study

Abstract

Background:Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered.Aim:This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients.Materials and Methods:A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, <50, 50–200, 201–500, >500, respectively.Results:The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count < 50. Majority of the infectious and non-infectious dermatoses were common in the CD4 count between 201–500 (Group III) and 50–200 (Group II). In the study groups, 52 cases (52%) were on antiretroviral therapy (ART), and the remaining 48 cases (48%) were not on ART at the time of diagnosis of mucocutaneous manifestations. Out of 48 ART-naïve cases, 23 patients were screened and newly diagnosed at the outpatient department (OPD) based on the mucocutaneous manifestations. Most of the patients with multiple mucocutaneous conditions were in the CD4 count <200, whereas single manifestation was seen predominantly in CD4 count >200.Conclusion:Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.

Seborrheic dermatitis—Looking beyond Malassezia

“…A status of chronic immune inhibition, such as that seen in organ transplant recipients and patients with HIV/AIDS, hepatitis C virus, alcoholic pancreatitis or some malignancies, is associated with a much higher incidence of SD . The SD incidence in HIV‐positive patients have been reported as high as 30% to 83%, and later stages of HIV infection and decreased CD4‐positive T cell counts are often associated with more severe SD . These findings suggest that suppression of certain types of immune cells may render some other immune cells more active, which may facilitate the development of SD.…”

Mucocutaneous disorders in HIV/AIDS at a tertiary care hospital in Nepal: An observational study

“…Mucocutaneous manifestations are common in HIV infections and may sometimes be their earliest manifestations. A variety of skin disorders occur during the course of HIV, such as infectious skin diseases, noninfectious skin diseases, and malignant skin conditions [1]. It is reported that almost 90% of people living with HIV (abbreviated to PLHIV) will develop skin symptoms during the course of the disease [2].…”

Clinico-etiological study of genital lesions at a tertiary care center in Pune, India

“…The diagnosis of DM was made for the first time in 8% of their patients by Verma and Celia et al found positive association between vulvovaginal candidiasis and diabetes mellitus. 13,14 In our study, none of the males were circumcised. Seven out of 12 diabetics had previously undetected diabetes and were diagnosed during evaluation for genital lesions.…”