Introduction
By the end of 2021, there will be roughly 38.4 million PEOPLE LIVING WITH HIV AND AIDS (PLHA) worldwide. In India, the prevalence of the Human Immunodeficiency Virus (HIV) was expected to be 0.55% in 2000, 0.32% in 2010, and 0.21% in 2021.1 HIV prevalence was estimated to be 0.22% in the adult male population and 0.19% in the adult female population. Maharashtra (3.94 lakh), Andhra Pradesh (3.21 lakh), Karnataka (2.76 lakh), Uttar Pradesh (1.78 lakh), Tamil Nadu (1.63 lakh), Telangana (1.56 lakh), Bihar (1.43 lakh), and Gujarat are the states/UTs expected to have the greatest number of PLHIV at more than 1 lakh apiece (1.14 lakh). Around 73% of the PLHIV burden is spread across these eight states. Many dermatological problems have proven to be helpful indicators of HIV infection progression and diagnosis. Around 90% of PLHA get skin problems at some point throughout their illness. 2 Although these illnesses are common in the general healthy population, they are frequently unusual, severe, and explosive in PLHA, necessitating prolonged treatment times.
Materials and Methods
A prospective observational study was conducted on 100 known HIV + people who visited the DVL OPD with symptoms of a skin condition. The Kurnool Medical College's ethical committee provided the study with its ethical approval. In every patient, a thorough physical examination and a detailed history were performed. Where applicable, investigations were carried out to confirm the patient's diagnosis. The tests that were sent included a full blood count, an ESR, a biopsy, a KOH mount, a full urine examination, a Mantoux test, an LFT, an RFT, and, when necessary, an x-ray chest PA view.
Observation and Results
There were 63 men and 37 women among the 100 cases that were examined. The age range of 31 to 40 years was represented by 32% of the patients [Figure 1]. The majority of the patients were in stage 2 of the WHO [Figure 2]. CD4 counts ranged from 201 to 500 for 50% of the patients (Table 1).
Table 1
Patients' distribution according to their CD4 counts
|
CD4 Count in cells/µl |
No. of patients |
Percentage (%) |
|
< 200 |
28 |
28% |
|
201 - 500 |
50 |
50% |
|
> 500 |
22 |
22% |
|
Total |
100 |
100% |
40% of patients with dermatological symptoms also experienced non-infectious symptoms, according to (Table 2). The majority of patients (45%) only had one manifestation, and [Table 3] when the CD4 level decreased, the number of manifestations rose. In 15 (34%) cases, seborrheic dermatitis was the most prevalent non-infectious symptom [Table 4]. The majority of infections were caused by fungi (48), the majority of bacterial infections were caused by pyogenic bacteria (07), the majority of fungal infections were caused by tinea, primarily tinea corporis and tinea cruris (18), and the majority of viral infections were caused by herpes zoster (11) and herpes genitalis (09), respectively [Table 5].
Table 2
Grouping of study participants with various dermatological manifestations.
|
Dermatological manifestations |
No. of patients |
Percentage (%) |
|
1. Infectious |
34 |
34% |
|
2. Non-infectious |
26 |
26% |
|
3. Both infectious and non-infectious |
40 |
40% |
|
Total |
100 |
100% |
Table 3
Grouping of patients as per number of manifestations
Table 4
Mean CD4 counts and No. of Non-infectious cutaneous manifestations
Table 5
Various infections and their CD4 count
Discussion
100 HIV-positive individuals with dermatological and STI manifestations who were DVL out-patients at Kurnool Medical College, Kurnool, were included in this prospective study. In the study, 100 patients were involved, of which 70 (70%) only had dermatological manifestations, 9 (9%) only had STIs, and 21 (21%) had STIs and dermatological manifestations.
The male:female ratio in the current study was 2:1, which is comparable to studies by Sen et al, 3 where it was 2:1, and Vijayakumari et al, 4 where it was reported to be 1.6:1. Of the 100 patients, 32 (32%), or the majority of the cases, were between the ages of 31 and 40. This demonstrates that the majority of HIV-positive people are among the most sexually active demographic. This is comparable to studies conducted by Dr. A. Kiranraju et al. 5 and Vijay Kumari et al. [04], which revealed 46% and 47%, respectively, of cases in the age category of 31 to 40. In this study, 48% of the patients were illiterate. The number of illiterates is equal to the 52.6% found in a survey by Jindal et al. 6 Patients made up a majority (55%) of unskilled workers. In comparison to studies by Jindal et al., where the percentage of unskilled workers among PLHAs was 39%, 6 and Kiran Raju et al., where it was 40%, 5 the percentage in the current study (55%) is greater.
The majority of the study group's patients (78%) had CD4 counts below 500 cells/µl, of which 28% had CD4 counts below 200 cells/µl. In contrast, Munoz-Perez et al's study revealed that 53% of patients had CD4 counts below 200 cells/µl. 7 The average CD4 count was 364 cells/µl, which is greater than the results of studies by Lt. Col. Biju Vasudevan et al 8 and A Vijaya Kumari et al 5 which showed 249 cells/µl and 274 cells/µl, respectively. In the current investigation, the CD4 count ranged from 54 to 1400 cells/µl. The patients' symptom counts ranged from 01 to 5, indicating that multiple manifestations could occur in a single patient and reinforcing the need for a thorough assessment of the patient. One manifestation was seen in 45 patients (45%), two manifestations in 30 patients (30%), three manifestations in 18 patients (18%), four manifestations in 6 patients (6%), with a mean CD4 count of 276 cells/µl, and five manifestations in 1 patient (1%), with a mean CD4 count of 149 cells/µl. Here, the relationship between the CD4 count and the number of manifestations is inverse. The most frequent disorders to manifest simultaneously were SD and PPE, which were observed in 05 patients and had a mean CD4 of 232 cells/µl.
In this study, fungal infections were most frequently seen as infections. In Infections, dermatophytic infections were found in 18 patients (18%). 06 patients had extensive tinea infection, with a mean CD4 count of 273 cells/µl. There were 13 patients (13%) who presented with oral candidiasis, which is comparable to the 15% seen in a research by Kiran Raju et al. 5 Oral candidiasis patients had an average CD4 level of 225 cells/µl. In our study, there were 7 cases of pyoderma, making it the most prevalent bacterial infection. The most frequent type of pyoderma observed was foliculitis. In this study, the mean CD4 cell count associated with pyoderma was 295 cells/µl, which is comparable to the study of Munoz-Perez et al,7 which found 357 cells/µl. The incidence of pyoderma was found to be 7% in this study, which is higher than the 5.6% reported by Sivayathom A and nearly identical to the 7.9% study by Jindal et al. 9
The most frequent viral infection seen in this study was Herpes zoster. Patients with HZ had an average CD4 count of 161 cells/µl. Herpes genitalis was detected in a total of 9 patients(9% of cases), and was the most frequent cause of STIs in the study, which is consistent with the majority of other studies like Shobana et al.(8%). One patient had ulcers in the perineal and penile area with a CD4 level of 54 cells/µl, and the other patient, an MSM, had a huge ulcer in the perineal area with a CD4 count of 97 cells/µl. Both patients had chronic, non-healing ulcers that took both patients around 6 weeks to heal.10
Seborrheic dermatitis 15(15%) and pruritic papular eruptions 13(13%) were the most frequent non-infectious manifestations. PPE had a mean CD4 count of 260 cells/µl, while seborrheic dermatitis patients had a mean CD4 count of 263 cells. In 8 patients (8%), xerosis/ichthyosis was observed, with a mean CD4 count of 329 cells/µl. Psoriasis was present in 04 participants in the current study, with a 4% frequency. A mean CD4 count of 437 cells/µl was observed. All individuals had significant scalp involvement in addition to severe body involvement.
In the study of 100 patients, a total of 28 (28%) had manifestations to the scalp and hair. 350 cells/µl was the average CD4 count in those who had hair changes. These include psoriasis, seborrheic dermatitis, and diffuse non-cicatricial alopecia.
Conclusion
Ages 21 to 40 constitute the most sexually active age range and are most frequently affected (58%); this suggests that sexual contact is the primary method of transmission. M:F ratio was 2:1 according to the distribution of the two sexes. The majority of PLHAs are from rural areas and are illiterate. The frequency of combined infected and non-infectious dermatological manifestations (40%) was the highest, followed by infectious (34%) and non-infectious (26%). The majority of the patients (50%) had CD4 counts between 201 and 500 cells/µl. The most prevalent infectious manifestation includes various forms of tinea, and was observed in 18 patients (18%), with a mean CD4 of 352 cells/µl. Seborrheic dermatitis, which was present in 15 patients (15%) and with a mean CD4 count of 263 cells/µl, was the most prevalent non-infectious manifestation. Oral candidiasis, which was present in 13 patients (13%) and had a mean CD4 of 225 cells/µl, was the most prevalent oral manifestation. The most prevalent STI was herpes genitalis.
The clinical markers for the progression of AIDS include Herpes Zoster (161), Scrofuloderma (169), Oral Candidiasis (225), PPE (260), and SD (263) as they have been linked to considerably lower CD4 counts.
The majority of PLHAs (55%) exhibited several manifestations. The majority of the manifestations are unusual, persistent, recurrent, and resistant to the therapy. Young patients presenting with extensive SD, PPE, OC, scrofuloderma, and HZ should encourage the clinician to investigate the patient's sero-reactivity status.
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