Mucocutaneous manifestations of HIV/AIDS patients admitted to tertiary care hospital, Bagalkot.

Introduction

Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/ AIDS) is a global pandemic. According to Global HIV & AIDS statistics 2018, approximately 36.9 million people are living with HIV globally, 77.3 million [59.9 million–100 million] people have become infected with HIV since the start of the epidemic, 35.4 million [25.0–49.9 million] people died from AIDS-related illnesses since the start of the epidemic and 940000 [670000–1.3million] people died from AIDS-related illnesses in 2017. It weakens a person’s immune system by destroying important cells that fight disease and infection. Dermatologic diseases are common in the HIVinfected population.HIV infection produces a  panorama of mucocutaneous manifestations which may be the presenting features of the disease ranging from the macular, roseola like rash seen in acute ‘seroconversion’ syndrome to extensive endstage Kaposi’s sarcoma. Skin disease may be the first presenting feature of the disease and it raises the suspicion to screen for HIV infection. Skin disease may provide the first suspicion of the diagnosis of HIV infection and can cause significant morbidity as the disease progresses and point to a diagnosis with important systemic complications.^1,2 This study is carried out to study the mucocutaneous manifestations of HIV/AIDS patients admitted to Tertiary care hospital in North Karnataka.

Materials and Methods

It is a Record based case series study. All HIV/ AIDS patients who were admitted in dermatology department & other departments with mucocutaneous manifestations for a period of one year were included in the present study. A predesigned questionnaire was used for the collection of data. Later data was entered in Microsoft excel. Percentages were used for the representation of data.

Result

Among 262 HIV/AIDS patients admitted, 61(23.29 %) had mucocutaneous manifestations (Table 1). Maximum of the study subjects were in the age group of 20-45 years constituting 78.7.Out of total 61 study subjects, 57.4% were males and 42.6% were females (Table 2). In our study, 57.35% of the subjects had Papular pruritus followed by Urticarial and Candidiasis with 13.11% each (Table 3). Maximum of the study subjects were in stage III (36.07%) followed by stage II (32.79%) (Table 4).

Discussion

In our study, 57.35% of the subjects had papular pruritus followed by Urticarial & Candidiasis with 13.11% each. Panda Set al³ studied that up to 90% of HIV positive patients had dermatological manifestations, but in present study we have only 23.29%. Kumarasamy N et al⁴ reported 8%, Mbuegbawet al³ documented 9.7% herpes zoster infection in HIV patients which is similar to present study with 6.55%Kumarasamy N et al5 observed that 5.7% of HIV patients had HSV-I ulcers which is similar to our study with 4.92% Kadyada Puttaiahet al⁵ observed that oral candidiasis-28%, papular pruritus-64%, herpes zoster-16%, HSV labialis-2%, furuncle-8% & pyoderma-2% in their study but in our study we have oral candidiasis-13.11%, papular pruritus-57.35%, herpes zoster-6.55%, HSV labialis-3.28%, furuncle-1.64% & pyoderma-3.28%. Sanjay Pande⁶ reported in his study that oral candidiasis contributed 22.77% & HZ 2.9%, our study shows 13.11% & 6.55% of oral candidiasis & HZ respectively. Harminder Singh⁷ found 22.5% of papular pruritus, 17.5 % of oral candidiasis in his study & our study shows 57.35% of papular pruritus, 13.11% of oral candidiasis. Kumarasamy N et al⁴ , Singh A et al⁸ , Misra SN et al⁹ , Ghate MV et al10, Ranganathan K et al¹¹, Anil S et al¹² observed that 70% of cases with HIV had candidial infection, but in our study it comprises only of 13.11%. In a study conducted in Tamilnadu, they observed Dermatophytosis (46) [Tinea cruris (25)>Tinea corporis (13) Tinea faciei (8)] was the most common cutaneous infectious conditions mostly found in males. 32 of them had more than one area involvement of dermatophytosis. This is followed by papular and follicular eruptions in HIV (34), hair disorders (29), seborrhoeic dermatitis (26), ichthyosis (15) and herpes zoster (11). These skin changes were also most frequently found in males. Among females, dermatophytosis followed by popular and follicular eruptions, hair disorders, herpes zoster, molluscum contagiosum and ichthyosis were frequently seen.13In a study conducted in Lahore, infectious and noninfectious manifestations were noted. The most common mucocutaneous lesions were observed viral infections in 90 (53.0%) patients, bacterial infections in 82 (48.2%) patients, fungal infections in 63 (37.0%) patients, hair changes in 51 (30.0%) patients, seborrheic dermatitis in 51 (30.0%) patients, parasitic infestation in 49 (28.8%) patients, oral candidiasis in 28 (16.5%) patients, drug reactions and hair changes in 17 (10.0%) patients, papulosquamous disorders 14 (8.2%) patients.14 We observe that astute clinical examination will elicit mucocutaneous diseases (with or without symptoms) in majority of the affected HIV population.

Conclusion

Papular pruritus was the most common presentation followed by Urticaria, Candidiasis & Herpes zoster. So any patients with these presentations can be suspected as a case of HIV & should be subjected for evaluation. Mucocutaneous disorders are useful clinical predictors of the HIV infection and play a unique role in HIV, as recognising HIV related skin changes may lead to diagnosis of HIV infection in the early stages, allowing initiation of appropriate ART. More efforts need to be put in educating and counseling the patients. A high level of suspicion for the HIV infection has to be kept in mind to prevent opportunistic infections and improving the patient’s quality of life