HIV/AIDS皮肤病变的临床分析

目的 探讨HIV/AIDS患者皮肤粘膜病变的临床特征及其与疾病进展的相关性。方法 对45例HIV/AIDS患者的皮肤病变进行临床分析,并同时检测其CD4细胞计数与HIV病毒载量。结果 45例HIV/AIDS患者中有30创(66.7％)伴有皮肤病变,其中以真菌和疱疹病毒感染引起的皮肤病最常见,各占66.7％;其次为脂溢性皮炎,占36.7％;其它类型的皮肤病占50.0％。90.0％的AIDS皮肤病变发生在CD4细胞数<200个/μl,HIV-RNA载量>4 log。而HIV/且AIDS皮肤病变随着HARRT治疗后而缓解。结论 HIV/AIDS皮肤病变发生率很高,早期诊断与治疗对于监测HIV/AIDS患者疾病的进展有重大意义。     

悉尼HIV感染者皮肤疾病的回顾性调查分析

目的：（1）调查悉尼某皮科诊所的HIV阳性患者的皮肤病发病情况；（2）发现近10年来HIV相关皮肤病的变化趋势。方法：1995～2005年的487例HIV阳性患者的病历资料进行回顾性研究。结果：487例患者中，有485例（99．6％）患有不同的皮肤病，平均每人2．55个诊断。日光相关性皮肤病有较高的发病率（39．8％），而一些传统的HIV相关的皮肤病则发病率较低。1998年之前首次就诊患者易患有病毒性和炎症性皮肤病，1998年后就诊的患者则患有多种类型皮肤病。结论：HIV与许多皮肤疾病有关联，近10年来HIV相关皮肤病病谱发生了很大的变化。     

艾滋病相关腹泻67例临床分析北大核心CSCD

目的了解高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)广泛应用时代艾滋病相关腹泻(HIV/AIDS related diarrhea,HRD)的临床特点。方法回顾性分析67例HRD患者的艾滋病(acquired immunodeficiency syndrome,AIDS)病程、发病诱因、疾病诊断、免疫功能等。结果 79.20%的患者感染人类免疫缺陷病毒(human immunodeficiency virus,HIV)病程超过10年,约86.50%患者腹泻病程大于3个月,65.60%的患者诊断为药物相关性腹泻。31例患者CD4^+T淋巴细胞50~350/μL,32例患者CD4^+T淋巴细胞>350/μL。结论 HAART时代,HRD患者HIV感染史长,以肠道免疫损伤、菌群异位等非感染性慢性腹泻临床常见,含LPV/r的二线治疗方案可增加其发生的危险,外周血CD4^+T淋巴细胞数高者腹泻发生率也高。     

人类免疫缺陷病毒感染相关皮肤病及其治疗

人类免疫缺陷病毒(HIV)为RNA逆转录病毒,主要感染CD4⁺细胞,导致免疫功能破坏,产生机会性感染、恶性肿瘤等,当CD4⁺细胞计数每mm³低于200个或出现某些临床疾病时,感染者进展为艾滋病(AIDS).HIV感染并发皮肤病主要包括感染性疾病(病毒、细菌、真菌感染)和非感染性疾病及肿瘤等,治疗HIV感染本身也会发生皮肤表现^[1],其中部分皮肤病仅见于HIV阳性个体,为早期诊断HIV感染提供第一线索,而另一些皮肤病可作为疾病进展的标志,与HIV感染相关的皮肤病通常表现较为严重或不典型、或治疗困难.高效抗逆转录病毒治疗(HAART)可明显减少一些皮肤病的发生,但也引起皮肤不良反应.     

艾滋病相关腹泻67例临床分析

目的了解高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)广泛应用时代艾滋病相关腹泻(HIV/AIDS related diarrhea,HRD)的临床特点。方法回顾性分析67例HRD患者的艾滋病(acquired immunodeficiency syndrome,AIDS)病程、发病诱因、疾病诊断、免疫功能等。结果 79.20%的患者感染人类免疫缺陷病毒(human immunodeficiency virus,HIV)病程超过10年,约86.50%患者腹泻病程大于3个月,65.60%的患者诊断为药物相关性腹泻。31例患者CD4~+T淋巴细胞50~350/μL,32例患者CD4~+T淋巴细胞350/μL。结论 HAART时代,HRD患者HIV感染史长,以肠道免疫损伤、菌群异位等非感染性慢性腹泻临床常见,含LPV/r的二线治疗方案可增加其发生的危险,外周血CD4~+T淋巴细胞数高者腹泻发生率也高。     

HIV/AIDS合并带状疱疹患者临床特征及发病相关因素分析

目的 探讨HIV/AIDS合并带状疱疹患者的临床特征及发病相关危险因素。方法 整群抽取2019年8月-2020年1月在大理市第二人民医院艾滋病抗病毒门诊就诊的715例HIV/AIDS患者为研究对象,分为病例组245例(HIV/AIDS合并带状疱疹患者)和对照组470例(无带状疱疹的HIV/AIDS患者),并以同期住院的146例HIV阴性带状疱疹患者为非HIV组。采集患者临床资料,用SPSS22.0软件进行统计分析。结果 HIV/AIDS患者带状疱疹发生率为34.27%,复发率为11.43%,重型带状疱疹发生率高。病例组患者平均年龄45.9岁,显著低于非HIV组带状疱疹患者。病例组平均CD4⁺T淋巴细胞为219个/μL,显著低于对照组403个/μL。HIV/AIDS患者发生第1次、第2次和第3次带状疱疹平均CD4⁺T淋巴细胞计数分别为268个/μL、143个/μL和50个/μL。低CD4⁺T淋巴细胞计数、合并病毒性肝炎为HIV/AIDS患者发生带状疱疹的危险因素,接受ART治疗为保护因素。结论 HIV/AIDS患者带状疱疹...     

赣州市2010-2014年新发HIV/AIDS病例首次CD4~+ T淋巴细胞检测结果分析

目的了解赣州市HIV/AIDS患者免疫水平及疾病进展情况,为其抗病毒治疗提供参考依据。方法将入选的564例HIV/AIDS病例首次血液标本采用流式细胞仪(FACScont)进行CD4~+T淋巴细胞绝对值检测。结果 564例HIV/AIDS患者的CD4~+T淋巴细胞中位数(四分位数间距)为256.00(277.75)个/μl,CD4~+T淋巴细胞绝对值≤200个/μL者占35.28%,201~350个/μL者占32.09%,351~500个/μL者占18.26%,500个/μL者占14.36%。不同性别HIV/AIDS患者CD4~+T淋巴细胞绝对值的中位数差异无统计学意义(P0.05),不同年龄和样本来源HIV/AIDS患者CD4~+T淋巴细胞绝对值的中位数差异有统计学意义(P0.05)。结论赣州市多数HIV/AIDS患者CD4~+T淋巴细胞免疫水平偏低,HIV感染者已经进入发病高峰期,应加强防控措施。     

HIV/AIDS慢性腹泻患者149例隐孢子虫感染分析

目的分析HIV/AIDS慢性腹泻患者中隐孢子虫感染情况、感染因素及流行特点,为防治隐孢子虫在AIDS患者中的感染提供依据。方法从河南省上蔡县收集AIDS慢性腹泻患者粪便标本149份,采用甲醛-乙酸乙酰沉淀法对患者粪便标本进行集卵,用改良抗酸染色法进行染色检测隐孢子虫卵囊。同时检测患者血液中CD4+T细胞计数。结果 149例HIV/AIDS慢性腹泻患者的粪便标本中24例为隐孢子虫阳性,感染率为16.11%。男性与女性患者及各年龄组感染率比较差异无统计学意义(P均>0.05);HIV/AIDS患者处于HIV无症状期、有症状期和HIV/AIDS期的隐孢子虫感染率分别为0(0/7),25.81%(16/62)和9.88%(8/81),其差异有统计学意义(P<0.05);患者CD4+T细胞水平在<200cells/μL,201～499cells/μL和>500cells/μL的隐孢子虫感染率分别为22.00%(11/50),13.68%(13/95)和0(0/21),差异有统计学意义(P<0.05)。结论 HIV/AIDS慢性腹泻患者中存在着隐孢子虫感染,中晚期患者随着病情的进展,特别是随着CD4+T淋巴细胞水平的降低,感染的危险性明显增高。     

HIV^＋／AIDS相关的皮肤粘膜损害

艾滋病（AIDS）是由人类免疫缺陷病毒（HIV）感染所致的传染病。HIV是一种逆转录病毒,能选择性结合CD4分子并侵入表达CD4的宿主细胞（主要是辅助性T淋巴细胞及树突状细胞）,导致机体免疫功能缺陷及免疫紊乱,出现机会性感染和恶性肿瘤。特别是表皮中树突状细胞（即郎格罕细胞）减少,抗原递呈功能受损,是导致皮肤黏膜损害的重要原因之一。感染HIV者普遍存在皮肤黏膜损害（90％可出现皮肤损害）,许多HIV^＋／AIDS患者以皮肤损害为首发症状,皮肤损害可作为HIV^＋／AIDS诊断的重要线索,也是免疫状况观察的重要指标。HIV^＋／AIDS相关皮肤黏膜损害可分为感染性皮肤病、肿瘤性皮肤病和炎症性皮肤病,简述如下。     

河南、山西2164例经血传播HIV/AIDS患者的皮肤表现分析

目的:观察和统计经血感染HIV/AIDS患者各种皮肤病的发生率.方法:通过回顾性分析,对河南、山西两地2164例经单采血浆或输血传播的HIV/AIDS住院和门诊患者皮肤病的发病情况进行总结.用流式细胞仪测定CD4T细胞计数.并将CD4T细胞计数和皮炎湿疹类疾病及念珠菌感染等进行相关性分析.结果:这一人群中皮肤病的发病率高达90%以上,最常见为皮炎湿疹类皮肤病,其次为口腔念珠菌感染和浅部真菌病.结论:HIV感染/AIDS患者皮肤病高发,河南、山西两地经血传播HIV人群中以皮炎湿疹类皮肤病及真菌感染最为多见.     

Skin Disease in Korean Human Immunodeficiency Virus Patient

BackgroundIn Korea, new human immunodeficiency virus (HIV) patients continue to be diagnosed. Due to the development of highly active anti-retroviral therapy (HAART) and lengthening of survival period of infected person, the aspect of skin diseases of HIV-infected patients is also changing.ObjectiveTo determine skin diseases of HIV-infected patients according to immune status and the relationship between folliculitis and HAART drug.MethodsSubjects were HIV-infected patients who were treated in the department of dermatology from September 1, 2008 to August 31, 2018. Medical records of 376 subjects were retrospectively analyzed.ResultsOf 376 patients were studied, tinea infection, folliculitis, and seborrheic dermatitis were the most common regardless of their CD4 T cell counts or treatment group (initial treatment or retreatment). Seborrheic dermatitis, irritant contact dermatitis, and pruritic papular eruption were significantly more common in patients with CD4+T cells less than 200×10⁶ cells/L while warts were significantly more frequent in patients with CD4+T cells greater than 200×10⁶ cells/L. Most HAART agents were found to be helpful in reducing the incidence of folliculitis.ConclusionThere were many skin diseases in HIV patients, different from previous studies. In our study, the top three diagnoses were tinea infection, folliculitis, and seborrheic dermatitis. HAART medication was helpful in reducing folliculitis. These changes will require different treatments for skin diseases in HIV patients.     

Clinical analysis of skin lesions in 796 Chinese HIV- positive patients

Skin lesions are often associated with human immunodeficiency virus (HIV) infection, reflecting the immunocompromised status of the individual. We investigated the relationship between skin lesions and immune function in a retrospective study of 796 Chinese HIV patients with and without highly active antiretroviral therapy (HAART). Of the 651 patients who had not received HAART, we found that 531 (81.6%) had apparent skin lesions. The incidence of infectious skin diseases (fungi, viruses, bacteria, spirochetes and parasites) and non-infectious skin diseases (excluding skin cancer) was 68.8% and 34.9%, respectively. Mean CD4(+) T-cell counts and CD4(+)/CD8(+) ratios were lower in patients with skin lesions than in patients without lesions (178 ± 96/μl vs. 306 ± 189/μl (p < 0.05) and 0.22 vs. 0.34 (p < 0.01), respectively). Candidiasis (25.8%), eczema (19.2%), nodular prurigo (13.8%), dermatophyte infections (10.6%) and herpes zoster (9.4%) were most common in Chinese patients with HIV. Among the 145 patients who had started HAART, there was a significantly lower prevalence of skin diseases (29.0%), although drug eruptions (12.4%) were more commonly observed. These findings indicate that HAART often reduces the incidence of infectious and non-infectious skin lesions in patients with HIV, but can itself be the cause of drug eruptions.     

Initiation of antiretroviral therapy in HIV‐infected adults with skin complaints in northern Tanzania

Abnormal skin findings are identified in over 90% of human immunodeficiency virus (HIV)‐infected persons globally. A prospective cohort study of HIV‐infected patients with skin complaints commencing antiretroviral therapy (ART) in northern Tanzania was undertaken. Consecutive HIV‐infected subjects presenting with skin complaints, who met criteria for ART initiation, were recruited at a Tanzanian Regional Dermatology Training Center. A single dermatologist evaluated all subjects; baseline skin biopsies were performed, and CD4⁺ cell counts and plasma HIV RNA levels were measured. All subjects received a fixed‐dose combination of stavudine, lamivudine, and nevirapine. A total of 100 subjects were enrolled; 86 subjects completed six months of follow‐up. Median baseline CD4⁺ cell counts and plasma HIV RNA levels were 120 cells/μl and 5.2 log₁₀ copies/ml. The most common dermatologic condition was papular pruritic eruption (47%). The median baseline score on the Burn Scale was 38%. After six months, 10 subjects had achieved the complete resolution of skin abnormalities. In those without complete resolution, the median Burn Scale score improved to 7%. Five patients developed new eruptions by month 3, which in two cases were attributed to drug reactions. In the 86 subjects remaining on ART after six months, the median CD4⁺ cell count had increased to 474 cells/μl, and plasma HIV RNA levels were <400 copies/ml in 85 (99%) subjects. Patients with HIV infection with skin complaints experienced marked clinical improvements following ART initiation.     

Pruritic papular eruption in HIV seropositive patients: a cutaneous marker for immunosuppression

BACKGROUND: Previous reports have shown the correlation between certain skin disorders and immune status in human immunodeficiency virus (HIV) infected patients. Pruritic papular eruption (PPE) is the most common cutaneous manifestation in HIV infected patients. The purpose of this study is to define the relationship between the presentation of PPE and the immune status in HIV infection, as measured by the T-cell subset, and to establish the usefulness of this common eruption as a predictor of CD4 count. METHOD: In this cross-sectional study, 20 HIV-positive patients with characteristics of PPE were studied. Clinical data, skin biopsy, and immune status, evaluated by measuring CD4, CD8, and CD4/CD8, were investigated. RESULTS: Seventy-five per cent of patients already had antecedent skin disorders, so PPE is not a leading symptom in HIV infected patients; 81.25% of PPE patients had an advanced degree of immunosuppression with a CD4 count below 100/mm3 and 75% below 50/mm3. CONCLUSIONS: PPE can be regarded as a cutaneous marker of advanced HIV infection.     

Prevalence of skin disorders in HIV patients in Senegal and relationship to degree of immunosuppression

BACKGROUND: The aim was to evaluate the association between dermatological findings in HIV-infected patients in Senegal and degree of immunosuppression and HIV stage. PATIENTS AND METHODS: All consecutive HIV infected patients followed up at three dermatology centres in Senegal from 01 January 2004 to 01 January 2006 were evaluated retrospectively regarding dermatological findings, CD4 cell count and HIV stage. PATIENTS AND METHODS: One hundred and forty-nine patients with 331 skin diseases were evaluated. The most common forms of dermatosis were oral candidiasis (53%), herpes zoster (24%), prurigo (24%) and dermatophytosis (16%). An increasing number of skin diseases was significantly associated with CD4 counts of below 200 per cubic millimeter and Aids diagnosis. A significant association (p<0.05) was found between two types of dermatosis (oral candidiasis and chromonychia) and CD4 counts of below 200 per cubic millimeter and between four types of dermatosis (straightened hair, herpes, oral candidiasis and xerosis) and Aids diagnosis. CONCLUSION: Dermatological findings are of great diagnostic and prognostic significance. We found some features specific to black skin: longitudinal melanonychia and blue ungueal pigmentation potentially related to immunosuppression and straightened hair, associated with Aids, probably resulting from denutrition.     

Spectrum of skin disorders in human immunodeficiency virus-infected patients in Singapore and the relationship to CD4 lymphocyte counts

BACKGROUND: Skin disorders are extremely common and cause significant morbidity in human immunodeficiency virus (HIV)-infected individuals. There are few data on their prevalence and association with CD4 counts in Asians. AIM: To evaluate the prevalence of skin disorders in ambulatory HIV-infected individuals attending a specialized skin clinic in Singapore and the association with the degree of immunosuppression. METHODS: A cross-sectional study on skin disorders in HIV-positive outpatients in the Communicable Disease Centre of Singapore was performed. The association between skin disease prevalence and CD4 count was evaluated using logistic regression. RESULTS: Ninety-six patients (male : female, 8 : 1) were enrolled. The most common mode of HIV transmission was heterosexual (75%), followed by homosexual/bisexual contacts (22%), and intravenous drug abuse (3%). The distribution of patients in terms of current CD4 cell counts was as follows: 38.5% with less than 50 x 10(6)/L, 25% with between 50 and 199/microL, and 36.5% with at least 200 x 10(6)/L. The most common skin disorder was pruritic papular eruption (PPE) of HIV infection (31 cases), followed by psoriasis (24), seborrheic dermatitis (18), xerosis (17), herpes simplex (17), and adverse drug eruptions (17). A CD4 cell count of less than 200 x 10(6)/L was significantly associated with a higher number of skin disorders (P = 0.002) and the development of psoriasis [odds ratio (OR), 8.97; 95% confidence interval (CI), 1.70-47.16; P = 0.010], PPE (OR, 3.40; 95% CI, 1.21-9.53; P = 0.020), and adverse drug eruption (OR, 5.83; 95% CI, 1.21-28.00; P = 0.028). CONCLUSIONS: A preponderance of inflammatory dermatoses and an absence of skin tumors characterized this study. A low CD4 cell count was associated with a higher number of skin disorders and an increased incidence of PPE, psoriasis, and adverse drug eruptions.     

Protracted cutaneous disorders in association with low CD4+ lymphocyte counts

Summary We report two patients with skin disorders usually associated with severe immunosuppression, who had low CD4⁺ lymphocyte counts but normal immunoglobulin levels. The patients were HIV negative, and had CD4⁺ lymphocyte counts just above 300/mm³, but they presented with cutaneous manifestations of profound immunodeficiency. Idiopathic CD4⁺ lymphocyte deficiency is a recently described syndrome which may present with dermatological disease. We discuss the symptom complex of our patients in relationship to the diagnosis of idiopathic CD4⁺ lymphocyte deficiency.     

Chronic actinic dermatitis as the presenting feature of HIV infection in three Chinese males

There have been a few reports in the literature of chronic actinic dermatitis (CAD) associated with HIV infection, mostly in African--Americans of skin type VI, where photosensitivity predated the diagnosis of HIV infection. We report three cases, all Chinese males with skin type III or IV, who presented to our centre with CAD, and in whom advanced asymptomatic HIV infection was subsequently diagnosed. All had CD4 cell counts less than 100 cells/ micro L, with no evidence of AIDS-related complex. They were treated conservatively with photoprotection and topical steroids with mild to moderate improvement. A comparison with nine previously reported cases is made. The pathogenesis of CAD is unclear, but predominance of CD8 cells in severe cases and reversal of the CD4 : CD8 ratio in lesional skin and peripheral blood of HIV-negative CAD patients has been observed. CAD may be consequent to, and a presenting feature of, advanced HIV infection.     

Skin disease: clinical indicator of immune status in human immunodeficiency virus (HIV) infection

BACKGROUND: Dermatological manifestations are seen at every stage of HIV/AIDS (human immunodeficiency virus), and are often the presenting features. These manifestations not only act as markers but also reflect the underlying immune status. OBJECTIVE: To establish skin diseases as clinical indicators of underlying immune status in HIV disease by estimating and correlating with the CD(4), CD(4) : CD(8) ratio. MATERIALS AND METHODS: The CD(4), CD(8), CD(4) : CD(8) ratios were estimated using the fluorescence activated cell sorter (FACS) count system in 20 asymptomatic HIV patients, 80 HIV patients with various skin manifestations and 72 healthy volunteers as the control group. RESULTS: In comparison with the CD(4) cell count of the control group (mean 885/mm(3), standard deviation 331), that of the HIV-positive individuals (mean 409.83/mm(3), standard deviation 263.07) was statistically correlated with low counts (z = 10.099 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. In comparison with the CD(4) cell count of the asymptomatic HIV-positive individuals (mean 620.65/mm(3) and standard deviation 262.065), the CD(4) cell count of the HIV-positive patients with various dermatological manifestations (mean 357.15/mm(3), standard deviation 236.95) was statistically correlated with low counts (z = 4.0978 and P < 0.05). Similarly there was statistical significance with the CD(4) : CD(8) ratio among these two groups. CONCLUSIONS: There was an inverse relation between the CD(4) counts and the incidence and severity of skin diseases in the HIV/AIDS patients. Cutaneous manifestations of HIV can be considered as good clinical indicators to predict and access the underlying immune status in resource-poor countries.