HIV and Skin Conditions

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Original Editor - Rosie Swift

Top Contributors - Rosie Swift and Kim Jackson  

Introduction

Dermatological problems occur in more than 90% of people with Human Immunodeficiency Virus (HIV). HIV is a virus that attacks the body's immune system and, without treatment, will progress into Acquired Immune-Deficiency Syndrome (AIDS), which is characterised by opportunistic infections that are usually fatal if untreated. Several infectious, inflammatory, and neoplastic skin and mucosal conditions can affect individuals with HIV infection. Some of these conditions occur at specific stages of HIV infection. This can provide important information about the progression of the condition and when to initiate appropriate therapy. The prevalence, spectrum and severity of skin and oral conditions increases as the CD4 count declines below 200 cells/mm3 . Although skin conditions are not a major cause of mortality, they provoke scratching, disfigurement, pain, sleep disturbance and psychological distress, severely impacting the individual's life.

Aetiology

Some skin conditions typically experienced by individuals with HIV are opportunistic infections, in that they take advantage of a weakened immune system. Other skin conditions result from an over active immune system in response to antiretroviral treatment, or as a side effect of the drugs themselves.

Common types of skin conditions in HIV

Kaposi Sarcoma - Kaposi sarcoma causes purple or brown spots on your skin or around your mouth, and can affect internal organs including the lungs, liver, and parts of the digestive tract where they can cause potentially life-threatening symptoms and breathing problems. Karposi sarcoma only occurs when the CD4 count is extremely low and, as such, is an AIDS-defining condition. Antiretroviral drugs have greatly reduced the incidence and it generally responds to radiation, surgery, and chemotherapy.

Seborrhoeic Dermatitis -

papular pruritic eruption

eosinophilic folliculitis,

tinea infections,

Herpes Zoster - Herpes zoster viral infection is caused by the same virus that causes chickenpox and can cause an outbreak of sores around the genital area or the mouth. It can also result in shingles, an extremely painful blistering rash on one side of the body. It is treated using antiviral medication.

scabies,

Molluscum Contagiosum - Molluscum contagiosum causes pink or flesh-colored bumps on the skin and is highly contagious, bing spread by skin to skin contact or simply by touching the same surface. It is treated using cryosurgery, laser or topical ointment.

Extensive Candidiasis - also known as thrush. Candidiasis is a fungal infection that causes a thick white layer to form on the tongue or inner cheeks. It can be managed with antifungal medications, mouth lozenges, and mouth rinses.

Stevens-Johnson syndrome

All adults (including pregnant women), adolescents and children with unknown HIV status presenting with the conditions listed above should be offered testing for HIV immediately.

All known HIV-infected adults (including pregnant women), adolescents and children presenting with the conditions listed above should be evaluated (by clinical criteria or CD4 count) for eligibility to initiate antiretroviral therapy (ART).  

Resources

• World Health Organization. Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults. World Health Organization; 2014.