Nail Changes in People Living with Human Immunodeficiency Virus: Observational and Cross-Sectional Study in a Third-Level Hospital

Abstract

<b><i>Introduction:</i></b> Nail changes in people living with human immunodeficiency virus (HIV) have been scarcely reported. The aim of this study was to establish the frequency and characteristics of nail alterations observed in adults with HIV infection in a third-level hospital in Mexico. <b><i>Method:</i></b> Observational and cross-sectional study carried out in 205 patients receiving care at the HIV/AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City. We performed a nail and iconographic assessment of both hands and toenails. We collected information of demographic and clinical variables, as well as drugs use, and antiretroviral treatment used by the participants through a questionnaire and from medical records. We performed direct cytological examinations and nail mycological cultures in participants with symptoms of onychomycosis. <b><i>Results:</i></b> The participants were predominantly male patients (91.2%), with a mean age of 41 (range 21–78) years, under antiretroviral therapy (91.2%), with a suppressed viral load (78.5%) and mean CD4+ lymphocyte count of 379.5 (range 20–1,162) cells/μL. Fitzpatrick’s IV phototype was prevailing in the studied population (70%). Nail changes were documented in 72.2% of the patients; being pigmentary changes (37.1%) and trauma (30.7%) the most frequent. Onychomycosis was observed in 26.3%; with total dystrophic onychomycosis as the most frequent clinical variant (68.5%). We obtained fungal isolates in 59.3% of participants and <i>Candida parapsilosis</i> was the most frequent of these (37.5%). <b><i>Conclusions:</i></b> We observed a high prevalence of nail changes with very diverse etiology, as well as a variety of nondermatophytic yeasts and molds isolates associated with cases with onychomycosis. These findings reinforce and confirm the need for routine nail examination and stress the importance of medical personnel working with people living with HIV to have broad knowledge of nail pathology.

Retrospective Analysis of Onychomycosis Risk Factors Using the 2003-2014 National Inpatient Sample

“…In a 2011 retrospective chart review study of 280 Mexican patients with HIV, 20% (N = 54) had onychomycosis [ 33 ]. In another observational cross-sectional study of 205 Mexican patients attending an HIV/AIDS clinic, 26.3% (N = 54) had onychomycosis, and HIV+ patients with versus without onychomycosis had lower CD4+ cell counts at 379.5 cells/μL versus 448 cells/μL respectively (no p-value reported) [ 34 ]. Therefore, our study corroborates that HIV infection may be a risk factor for onychomycosis, which may help to inform screening guidelines.…”