Site Under Construction

Prevalence of mucosal and cutaneous disorders among HIV/AIDS adult Filipino patients 18-60 years old seen in a tertiary hospital in Makati City

Rahina H. Galvez, MD, DPDS, Ma. Jasmin J. Jamora, MD, FPDS, Janice C. Caoili, MD

Abstract

Introduction

With the recent rise in number of HIV/AIDS patients in the Philippines, knowledge of the most common mucosal and cutaneous findings among HIV/AIDS patients can be a valuable tool of assessment.

 

Objectives
To determine the different mucosal and cutaneous disease findings of HIV/AIDS patients; evaluate their frequency and association with the latest CD4 cell counts, and to determine patients’ demographic and medical profiles.

 

Methods

This is a cross-sectional study done at a tertiary hospital in Makati city from January 2017 to September 2018. Walk-in patients or those referred by Infectious Disease specialists were evaluated using a standardized history and physical examination form. Latest CD4 counts were also obtained.

 

Results

A total of 93 patients were enrolled. Majority were males (98%), with a mean age of 32 +/- 7.08, employed (64%), and on HAART (87%). A large part of the group (45%) has severe immunosuppression (CD4 counts <200/mm3). The most common manifestations were the following: non-infective, fungal, and drug-related dermatoses, with the most common dermatoses being seborrheic dermatitis, xerosis, pruritic papular eruptions (PPE), superficial fungal infections, drug hypersensitivity reactions, and syphilis. PPE was noted to be significantly associated with low CD4 counts.

 

Conclusion

Due to small population size, significant associations between the other dermatoses with their CD4 counts were not seen except for PPE, which was significantly associated with CD4 counts <200/mm3. Nevertheless, a strong suspicion for any underlying HIV//AIDS infection is still warranted in the presence of these dermatoses.

References

  1. Oninla O. Mucocutaneous Manifestations of HIV and the correlation with WHO clinical staging in a tertiary hospital in Nigeria.Department of Dermatology and Venereology, Faculty of Clinical Sciences, College of Health Sciences. AIDS Research and Treatment. 2014.
  2. Chawhan SM, Bhat DM, Solanke SM. Dermatological manifestations in human immunodeficiency virus infected patients: Morphological spectrum with CD4 correlation. Indian J Sex Transm Dis AIDS. 2013;34(2):89-94.
  3. Raju PV, Rao GR, Ramani TV, Vandana S. Skin disease: clinical indicator of immune status in human immunodeficiency virus (HIV) infection. Int J Dermatol. 2005 Aug;44(8):646-9. doi: 10.1111/j.1365-4632.2004.02067.x. PMID: 16101864.
  4. Lowe S, Ferrand RA, Morris-Jones R, Salisbury J, Mangeya N, Dimairo M, Miller RF, Corbett EL. Skin disease among human immunodeficiency virus-infected adolescents in Zimbabwe: a strong indicator of underlying HIV infection. Pediatr Infect Dis J. 2010 Apr;29(4):346-51. doi: 10.1097/INF.0b013e3181c15da4. PMID: 19940800; PMCID: PMC3428906.
  5. Nnoruka EN, Chukwuka JC, Anisuiba B. Correlation of mucocutaneous manifestations of HIV/AIDS infection with CD4 counts and disease progression. International Journal of Dermatology, vol. 46, pp. 14–18, 2007.
  6. Department of Health HIV/AIDS and ART Registry of the Philippines. January 2021.
  7. Pan X, Wu M, Ma Q, Wang H, Ma W, Zeng S, et al. High prevalence of HIV among men who have sex with men in Zhejiang, China: a respondent-driven sampling survey. BMJ Open. 2015 Dec 11;5(12):e008466. doi: 10.1136/bmjopen-2015-008466. PMID: 26656982; PMCID: PMC4679937.
  8. Joshi HS, Das R, Agnihotri AK. Clinico-epidemiological profile of HIV/AIDS patients in western Nepal a study from teaching hospital. Indian Journal of Preventive and Social Medicine. 2004;35(1-2):69–76.
  9. Kaur R, Dhakad MS, Goyal R, Bhalla P, Dewan R. Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in Tertiary Care Hospital in India. Canadian Journal of Infectious Diseases and Medical Microbiology, vol. 2016, Article ID 2373424, 7 pages, 2016.
  10. Kaprowicz V, Achkar J, Wilson D. The Tuberculosis and HIV Epidemic in South Africa and KwaZulu-Natal Research institute for Tuberculosis and HIV. Journal of infectious Diseases, Vol. 204, November 15, 2011.
  11. Forrestel AK, Kovarik CL, Mosam A, Gupta D, Maurer TA, Micheletti RG, et al. Diffuse HIV-associated seborrheic dermatitis – A case series. Int J STD AIDS. 2016;27:1342–5
  12. Blanes M, Belinchón I, Merino E, Portilla J, Sánchez-Payá J, Betlloch I. Prevalencia y características de las dermatosis relacionadas con la infección por VIH en la actualidad [Current prevalence and characteristics of dermatoses associated with human immunodeficiency virus infection]. Actas Dermosifiliogr. 2010 Oct;101(8):702-9. Spanish. PMID: 20965013.
  13. Kaushik SB, Cerci FB, Miracle J, Pokharel A, Chen SC, Chan YH, et al. Chronic pruritus in HIV-positive patients in the southeastern United States: its prevalence and effect on quality of life. J Am Acad Dermatol. 2014 Apr;70(4):659-664. doi: 10.1016/j.jaad.2013.12.015. Epub 2014 Feb 4. PMID: 24503217.
  14. Mirnezami M, Zarinfar N, Sofian M, Botlani Yadegar B, Rahimi H. Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4
    Lymphocyte Counts. Scientifica (Cairo). 2020 Aug 11;2020:7503756. doi: 10.1155/2020/7503756. PMID: 32850174; PMCID: PMC7439183.
  15. Lee D, Benson CA, Lewis CE, Grunfeld C, Scherzer R. Prevalence and factors associated with dry skin in HIV infection: the FRAM study. AIDS. 2007;21(15):2051-2057.
  16. Mischo M, von Kobyletzki LB, Bründermann E, Schmidt DA, Potthoff A, Brockmeyer NH, et al. Similar appearance, different mechanisms: xerosis in HIV, atopic dermatitis and ageing. Exp Dermatol. 2014 Jun;23(6):446-8. doi: 10.1111/exd.12425. PMID: 24758518.
  17. Eisman S. Pruritic papular eruptions of HIV-1. Dermatology Clinic 2006;24:449-57.
  18. Prabhakaran N, Jaisankar TJ, Hamide A, Malathi M, Kumari R, Thappa DM. Effect of antiretroviral therapy on mucocutaneous manifestations among Human Immunodeficiency Virus-infected patients in a tertiary care centre in South India. Indian J Sex Transm Dis AIDS. 2015;36(2):166-173.
  19. Mutagoma M, Nyirazinyoye L, Sebuhoro D, Riedel DJ, Ntaganira J. Syphilis and HIV prevalence and associated factors to their co-infection, hepatitis B and hepatitis C viruses prevalence among female sex workers in Rwanda. BMC Infect Dis. 2017 Jul 28;17(1):525. doi: 10.1186/s12879-017-2625-0. PMID:
    28754104; PMCID: PMC5534065.
  20. Dai W, Luo Z, Xu R, Zhao G, Tu D, Yang L, et al. Prevalence of HIV and syphilis co-infection and associated factors among non-commercial men who have sex with men attending a sexually transmitted disease clinic in Shenzhen, China. BMC Infect Dis. 2017 Jan 18;17(1):86. doi: 10.1186/s12879-017-2187-1.
    PMID: 28100187; PMCID: PMC5241916.

REquesting Permission

Prevalence of mucosal and cutaneous disorders among HIV/AIDS adult Filipino patients 18-60 years old seen in a tertiary hospital in Makati City