Authors: Imee P. Rajagukguk M.D., Maria Teresita Gabriel M.D. FPDS and Reynaldo Ugalde M.D. FPDS
Background: Cutaneous manifestations are common clinical findings among HIV-positive patients and may be the first presentation of HIV disease. The causes are bacteria, viruses, fungi and other non-infectious agents. In the Philippines, data on prevalence of skin diseases in HIV and association with CD4 counts is limited.
Objective: To determine the cutaneous manifestations seen in HIV-positive patients and their association with the degree of immunosuppression based on CD4 count.
Methods: A retrospective chart review study on skin disorders of HIV-positive outpatients in the Department of Dermatology at the Research Institute for Tropical Medicine, Philippines from January 2004 to December 2013 was conducted. Demographic data, most common cutaneous manifestations, and its correlation with CD4 counts were determined.
Results: Six-hundred-fifty-five patients (male: female, 11:1) were enrolled in the study. Majority of patients were males (90.7%) and between18-29 years old (53.3%) with a mean age of 30.39 years (±7.9). Patients were mostly college graduates (75.6%) and employed (82.70%). The most common cutaneous manifestations were viral skin infections (33.6%), non-infective dermatosis (30.4%), bacterial skin infections (20.6%), and fungal skin infections (11.6%). A CD4 count <200/mm3 was significantly associated with a higher number of skin disorders (p=0.000), development of viral skin infections [relative risk (RR), 5.1; 95% conﬁdence interval (CI) 3.36–7.71; p = 0.000], bacterial skin infections [RR, 3.2; 95% CI 2.02- 5.23; p = 0.000], and fungal skin infections [RR, 16.8; 95% CI 6–42.5; p = 0.000].
Conclusion: The skin lesions associated with HIV-positive patients are protean, but viral, bacterial, and fungal manifestations were most commonly observed. The skin lesions were highly associated with immunosuppression based on diminishing CD4 counts. In resource-poor settings where diagnostic facilities are limited, the presence of these cutaneous lesions should alert the dermatologist to the progression of HIV disease.
Rajagukguk, I, Gabriel, MT & Ugalde, R. (2017). Cutaneous manifestations of patients with HIV infection at the Research Institute for Tropical Medicine Dermatology Outpatient Department: A 10-year review. Journal of the Philippine Dermatological Society, 26(2), 41-46.
cutaneous manifestation, skin disease, HIV, CD4 count
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