Understanding Cutaneous Manifestations of HIV and AIDS
Human Immunodeficiency Virus (HIV) is a lentivirus that infects CD4 T lymphocytes, leading to Acquired Immunodeficiency Syndrome (AIDS). Cutaneous manifestations of HIV/AIDS vary depending on the stage of infection and CD4 T cell counts. Early signs include exanthem, oral hairy leukoplakia, candidiasis, psoriasis, seborrheic dermatitis, herpes zoster, and Kaposi sarcoma. Late-stage manifestations are often severe and may involve various infections, inflammatory conditions, and neoplastic diseases. Recognition of these dermatological signs can aid in early diagnosis and management of HIV/AIDS.
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CUTANEOUS MANIFESTATION OF AIDS DR .Anwar Issa Hasan 13/12/2018
HUMAN IMMUNODEFICIENCY VIRUS HIV: is lentivirus , member of retroviral family ,two type HIV1 &HIV2 . Its RNA ,with Reverse transcriptase enzyme . This virus infected human CD4 T lymphocytes ,by attachment to the specific cell surface (CCR5) receptors & use human cellular DNA for replication . Mode of transmission: sexually transmitted disease ,but also can transmitted by all body fluid of infected persons , contaminated needles in IV drugs users , vertical transmissions from mother to her baby . This virus cause AIDS ( acquired immunodeficiency syndrome). Actively treated with ART ( antiretroviral therapy). In HIV several cutaneous diseases ( disseminated coccidioidomycosis & Kaposi s sarcoma ) are AIDS defining conditions , whereas Seborrheic dermatitis & oral hairy leukoplakia can sever as clue for early diagnosis .
CUTANEOUS MANIFESTATION OF HIV INFECTION Its depending on : stage of viral infection , viral load & CD4 T lymphocytes accounts. Cutaneous manifestation are ; 1. Exanthem of primary HIV infection : occurs after incubation periods of 3-6 weeks Morbilliform eruption :appears in setting of peak viremia accompanied by orogenital ulceration , fever ,fatigue ,headache , pharyngitis , arthralgia , myalgia & GIT symptoms . Decrease in circulating CD4 lymphocytes. Rash last 4-5 days & constitutional symptoms last few days to few months. Dx :PCR to detects viral RNA in serum of patient & P24 antigen in plasma.
CUTANEOUS MANIFESTATION OF AIDS 2. Cutaneous manifestation of AIDS: number of cutaneous diseases that can point to HIV diagnosis ,usually sever , disseminated , may atypical presentations & reluctance to the treatments , including infections ,inflammatory diseases and neoplastic conditions . Types of cutaneous disease depend on CD4 T lymphocytes accounts so we divided its into 2 stages Manifestation of early stage ( CD4 T cell > 500 cell/mm3). Manifestation of late stage (CD4 cell <200 cell/ mm3).
MANIFESTATION OF EARLY STAGE 1. Acute retroviral syndrome. 2. Oral hairy leukoplakia : corrugated white plaques with hair like projections ,on the lateral aspect of tongue ,asymptomatic , caused by EBV infection. 3. Candidiasis: recurrent vaginal or oropharyngial candidiasis (oral thrush). 4. Psoriasis : new onset or exacerbation of preexisting psoriasis ,sever ,may resistant to treatments. 5. Seborrheic dermatitis : sever SD , involved face & scalp . 6. Herpes zoster : sever , multidermatomal , atypical ,may associated with systemic complications e.g. hepatitis ,encephalitis & pneumonia . 7. Kaposi sarcoma : disseminated ,typically involved mucosal membrane e.g. oral mucosa ,atypical with burse like lesions or large papules or ulcerative nodules or even verrocus ,may metastasis to GIT . 8. Eruptive atypical melanocytic nevi & melanoma.
MANIFESTATION OF EARLY STAGE Oral hairy leukoplakia Sever psoriasis in AIDS patient
MANIFESTATION OF LATE STAGE 1. Distributed on head & upper trunk , culture negative &biopsy show dermal infiltration with eosinophil. 2. Opportunistic infections : Cutaneous tuberculosis & other mycobacterial infections. Disseminated deep fungal infection e.g. Histopalsmosis ,cryptococcosis. Botryomycosis. Bacillary angiomatosis :due to grame negative bacilli called bartonella henselae & quintana. Eosinophilic folliculitis : itchy ,follicular papules with excoriation,
MANIFESTATION OF LATE STAGE Viral infections :herpes simplex virus ( Periorificial ,ulceration for one month duration), CMV perianal ulcer . Aspergillosis Giant molluscum : multiple large size papules ,involved face of adult person. 3. Acquired ichthyosis . 4. Major aphthosis(aphthous ulcers). 5. Non Hodgkin lymphoma . 6. Papular pruritic eruption. 7. Proximal white onychomycosis.: Dermatophytes infection of nail plate.
MANIFESTATION OF LATE STAGE Eosinophilic folliculitis Major aphtous ulcer
Opportunistic infections Giant molluscum HSV infection
CUTANEOUS MANIFESTATION OF AIDS 3. Immune reconstruction inflammatory syndrome : those disorders that can flare or worsen due to increase in ability to mount an inflammatory response following the institution of ART. INFECTIONS: viral ,bacterial ,Dermatophytes, mycobacterial & deep fungal . Inflammatory disorders : psoriasis ,eczema, AA, SD, sarcodosis & acne vulgaris. Neoplasms: Kaposi s sarcoma & non Hodgkin lymphoma .
DIAGNOSIS OF HIV INFECTION Diagnosis of HIV infection by serological detection of viral antigens or antibodies : 1. ELIZA: IgM or IgG . 2. Western blot test : IgG . 3. PCR : for viral RNA . 4. Viral culture . 5. Antigenic capture :for viral P24 OR gp 120 Ags.
ANTIRETROVIRAL THERAPY (ART) ART : usually include combination of two antiviral drug e.g. NRTI+nNRTI (typically tenofovir and Efavirenz), antiviral therapy classes are: 1. Nucleoside Reverse transcriptase inhibitors :Lamivudine & tenofovir. 2. nNRTI: Efavirenz. 3. Protease inhibitor: Indinavir. 4. CCR5 inhibitor : Maraviroc . 5. Fusion inhibitor :Enfuvirtide . 6. Integrase inhibitor :Raltegravir .
