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A hospital based cross sectional study of mucocutaneous manifestations in the HIV infected

Background: HIV infection produces a panorama of mucocutaneous manifestations ranging from macular, roseola like rash in the acute seroconversion illness to end-stage, extensive Kaposi sarcoma. Certain studies showed dermatological lesions are indicators of the immune status of the patient. So here is an attempt to find out the spectrum of dermatological lesions in HIV infected, their association with the CD4+ cell count, and to compare the pattern of dermatological lesions between patients on HAART and patients not on HAART.

Aims: To conduct a clinical study of mucocutaneous manifestations in HIV-positive patients visiting Skin and STD Dept. of Krishna Rajendra(K.R.) hospital, Mysore Medical College and Research Institute, with special reference to age, gender and risk factors.

Methodology: Cross-sectional study with simple random sampling technique was conducted at K.R.Hospital, Mysore Medical College and Research Institute, India between August 2007 and October2008. The study involved 350 HIV positive patients aged between 16-60y of which 175 were on HAART presenting with some mucocutaneous manifestations and 175 were not on HAART consisting of patients who presented with a symptom of one of the mucocutaneous lesions. They did not know if they were HIV infected. After they were tested they were found to be positive and were included in the study. They were procured from the Anti Retroviral Centre of our hospital. Mean duration of HAART initiated life is 6months. Before involving the patients in the study ,written informed consent was obtained from the patient/legal guardian both in English and local language. Appropriate lab investigations were done i.e. HIV status, base line investigations like Hemoglobin, Peripheral Blood Smear, KOH test, VDRL test, CD4 cell count etc.., The data thus collected was tabulated with reference to some important parameters of the study. It was analysed using the software SPSS 11.4version

Results: Among the opportunistic infections and other infectious lesions (HAART and non-HAART put together), highest was viral(56%) followed by fungal (42%), bacterial(22%) and least being infestation. Viral infections were less on HAART initiated(32%) as compared to non HAART(80%). But the cases of bacterial and fungal infections were almost equal in both categories. There was significant increase in the cases of non infectious lesions on HAART population(88% against 40% in non HAART; p<0.034) due to drug eruptions and pruritic papular eruption. One case of pityriasis rosea in non HAART, resistant to treatment was diagnosed. When opportunistic manifestations among non-HAART were considered , oral candidiasis was the leading manifestation seen among the 28% of the study group with mean CD4 count of 150cells/, followed by molluscum contagiosum- 24%,condyloma accuminatum-20% and herpes zoster-16%. Majority of the lesions were seen at the cell counts less than 200cells/ The study was comparable to many Indian and foreign studies.

Conclusions: In correlation with CD4 cell count, mucocutaneous manifestations increased with decreased CD4 cell count [Regression Coefficient (-0.31) with 0.64 standard error of estimate and p-value <0.05]. When dermatological lesions of patient who are on HAART was compared with that of non- HAART, there was significant reduction in the prevalence of dermatological viral infection in CAT 2[under HAART-chi square=5.134; p<0.023].But prevalence of bacterial and fungal infections showed no change [p=0.763(NS) and p=0.827(NS) respectively].This may be due to poor socioeconomic status and poor hygiene.

Author(s): Kadyada Puttaiah Srikanth, Sunith Vijayakumar, Aparna, Mallikarjun

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