Mucocutaneous findings in pediatric AIDS related to degree of immunosuppression

The normal value of the absolute CD4-positive T-lymphocyte count is relatively high in normal infants and declines steadily until 6 years of age, whereas the CD4 percentage of the total lymphocyte count is constant. The immunologic categories according to the 1994 revised pediatric human immunodeficiency virus (HIV) classification, based on CD4-positive percentage of the total lymphocyte count, is classified into three categories: no evidence of suppression (> or =25%), moderate suppression (15-24%), and severe suppression (1-14%). Our objective was to determine the prevalence of mucocutaneous findings in pediatric acquired immunodeficiency syndrome (AIDS) related to the degree of immunosuppression. We prospectively examined 120 children less than 13 years of age who were born to HIV-seropositive women and developed definite HIV infection. The prevalence of mucocutaneous findings in those children who had severe, moderate, and no evidence of immunosuppression were 62%, 43%, and 20%, respectively. The mucocutaneous findings in patients in the moderate and severe suppression groups were significantly more common than in patients without evidence of immunosuppression (p < 0.001). In the moderate immunosuppression group, 11% had two mucocutaneous findings while 21% in the severe immunosuppression group had two or more mucocutaneous findings. The most common mucocutaneous finding was oral candidiasis (33%), which had a mean corresponding CD4 percentage of the total lymphocyte count of 11.3%. Herpes zoster was found in 6% of the patients (mean CD4 percentage of the total lymphocyte count = 13.5%). Chronic herpes simplex virus (HSV) stomatitis was found in 3% of the patients (mean CD4 percentage of the total lymphocyte count = 3%). Mucocutaneous manifestations are common in pediatric AIDS. The majority of these findings have an infectious etiology. The prevalence increases as the CD4-positive percentage of the total lymphocyte count decreases. More than one mucocutaneous finding can be found at the same time in patients with moderate or severe immunosuppression.     

Use of etanercept in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients

BACKGROUND: Etanercept (Enbrel, Amgen, Thousand Oaks, CA), a soluble p75 tumor necrosis factor receptor:FC (TNFR:FC) fusion protein for plasma cytokines, specifically tumor necrosis factor-alpha (TNF-alpha), is used in the treatment of immune-mediated rheumatic diseases. To our knowledge, the use of etanercept in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is relatively uncommon. OBJECTIVE: The main purpose of this short review is to examine the safety of etanercept in patients with HIV/AIDS. METHODS: A Medline search was conducted using the keywords etanercept and HIV and/or AIDS for any published articles between 1966 to the present (September 2004). RESULTS: A case report, one case series, and one clinical trial pertained to the use of etanercept in HIV patients. No reports were found on the use of etanercept in AIDS. In addition, two case reports were found documenting the use of infliximab in HIV patients. DISCUSSION: Preliminary reports indicate that the administration of etanercept does not appear to increase the morbidity or mortality rates in HIV. The inhibition of TNF-alpha may actually improve the symptoms of HIV/AIDS-associated aphthous ulcers, cachexia, dementia, fatigue, and fever, as well as help manage concomitant rheumatic diseases and psoriasis. CONCLUSION: The use of etanercept shows promise for applications in disease management in patients with HIV/AIDS. Continued research efforts are necessary to establish the long-term safety and efficacy of etanercept and other biologic agents in this patient population.     

Malignant syphilis in a patient with acquired human immunodeficiency virus (HIV) infection

Malignant syphilis is an uncommon variant of syphilis, most often (but not always) found in immunosuppressed individuals. This report describes the case of a 57-year-old man, infected with the acquired human immunodeficiency virus (HIV), with a generalized picture of erythematous-squamous papules that rapidly progressed to painful and ulcerated plaques and nodules, some covered with a black rupioid crust. The analytical study performed revealed positive VDRL (Venereal Disease Research Laboratory) and RPR (Rapid Plasma Reagin). The skin biopsy was nonspecific; however, the immunohistochemical analysis disclosed the presence of spirochetes. The patient was then treated with benzathine penicillin G 2.4 MU once a week IM for three weeks, with progressive resolution of the lesions. Considering its rarity, this atypical form of syphilis that needs to be known to better recognize its clinical presentation and provide more prompt treatment to patients.     

Mucocutaneous manifestations of disseminated histoplasmosis in patients with acquired immunodeficiency syndrome: particular aspects in a Latin-American population

BACKGROUND: Mucocutaneous lesions in human immunodeficiency virus (HIV)-infected patients with disseminated histoplasmosis have a wide spectrum of clinical manifestations, making its diagnosis difficult. Studies have been restricted to case reports and series with small numbers of patients not specifically focusing on the dermatological aspects of histoplasmosis. AIMS: To describe the characteristics of mucocutaneous lesions of disseminated histoplasmosis in HIV-infected patients. METHODS: A retrospective and prospective study was conducted on 36 HIV-infected patients with mucocutaneous histoplasmosis in a tertiary-care hospital in Brazil. RESULTS: Mucocutaneous histoplasmosis was diagnosed by histopathology in 33 of the 36 patients (91%) and/or culture in 23 (64%). Their CD4+ cell counts ranged from 2 to 103 cells/mm(3). The average number of different morphological types of lesions was three per patient. Despite the variability of the lesions, papules (50%), crusted papules (64%) and oral mucosal erosions and/or ulcers (58%) were the most frequent dermatological lesions. A diffuse pattern of distribution of the skin lesions was found in 58% of the cases. There was significant association between the CD4+ cell counts and the morphological variability of lesions per patient. Variation in the lesions seemed to be associated with higher CD4+ cell counts. CONCLUSION: Doctors caring for HIV-infected patients should be aware of the wide spectrum of dermatological lesions observed in disseminated histoplasmosis and the importance of detecting and isolating the fungus in mucocutaneous tissues.     

Salivary gland disease in human immunodeficiency virus/acquired immunodeficiency syndrome: A review

The effect of human immunodeficiency virus(HIV) infection on salivary glands has diagnostic and prognostic significance. HIV-salivary gland disease(HIV-SGD) is comprehensively ascertained amongst the major critical acquired immunodeficiency syndrome(AIDS)-relatedoral manifestation and causes substantial morbidity. Parotid gland swelling due to sicca syndrome, parotid lipomatosis, sialadenitis, diffuse infiltrative lymphocytosis syndrome, benign lymphoepithelial lesions, neoplasms(benign or malignant) of salivary gland, parotid gland inflammation, diminished flow rates of saliva and xerostomia have been documented that also affects the health- associated characteristics of life in subjects infected with HIV. There is a necessity for health care researchers to diagnose it, particularly as it might worsen if left undiagnosed. The precise characteristic of alterations in dynamics of salivary gland structure and functionality with long-standing usage of highly active anti-retroviral therapy still remains unknown. HIV positive children also present with bilateral parotid enlargement and the syndrome state with classical clinical and cytological features of predominated lymphoid hyperplasia. Though various case reports and studies have been extensively published on different aspects of HIV-SGD, it has not been described solely, thus leading to occasional confusion of nomenclature and clinical presentation of HIV-SGD. This article reviews the pathogenesis of HIV-related SGD and its components and various other miscellaneous disorders affecting the salivary glands in HIV/AIDS.     

Knowledge and attitude regarding human immunodeficiency virus/acquired immunodeficiency syndrome in dermatological outpatients

Background  Dermatologists are often the first-line specialists who recognize and diagnose human immunodeficiency virus (HIV) infection because of pathognomic skin signs. It is therefore important to investigate attitudes and knowledge regarding HIV/acquired immunodeficiency syndrome (AIDS) amongst dermatological patients in order to provide information for dermatologists and to draw their attention to the issues.
Objectives  Awareness of HIV/AIDS, its prevention, and hypothetical behaviour were surveyed in dermatological outpatients.
Patients/method  The anonymous cross-sectional survey was conducted with consecutive German-speaking outpatients aged 18–65 years, who registered at the dermatological outpatient's clinic (excluding venereology, genitourinary or HIV medicine) of the University of Munich (Germany).
Results  Three hundred forty-seven (77.5%) questionnaires were accepted for analysis. Most of the patients knew about HIV incurability (89.4%), HIV transmissibility during needle sharing (95.3%), or vaginal (87.4%) and anal intercourse (79.5%), as well as about HIV prevention by condom use (97.8%), and use of single needles (76.2%). However, knowledge gaps and misconceptions were detected regarding the risk of HIV transmission during oral sex, and the efficacy of sexual fidelity and avoidance of blood transfusions in HIV prevention. The lowest knowledge level (< 50% correct answers) was detected in patients aged 50–59 years, in unemployed, divorced/widowed, and in those without or with incomplete school education.
Conclusions  Patient education about HIV/AIDS in dermatological ambulant settings should be performed differentially with regard to socio-demographic factors, and focused on the topic of oral sexual HIV transmission and on some other specific misconceptions.

Conflicts of interest

None declared.     

Disseminated granuloma annulare as a presentation of acquired immunodeficiency syndrome (AIDS)

Localized granuloma annulare is the commonest form of a granulomatous dermatosis characterized by flesh coloured or violaceous papules often arranged in rings. Several rare atypical variants are also reported including disseminated or generalized, subcutaneous and perforating types. There is a predilection for females and a documented association with diabetes mellitus in some cases. Recently it has been suggested that atypical variants of granuloma annulare might be associated with the acquired immunodeficiency syndrome (AIDS). We describe a patient presenting with extensive generalized granuloma annulare in whom an underlying diagnosis of Human Immunodeficiency Virus (HIV) disease was confirmed.     

筛查确诊的人免疫缺陷病毒感染52例分析

目的 探讨人类免疫缺陷病毒(HIV感染/艾滋病)的流行现状及其临床特点.方法 回顾性分析2006-2011年,由上海市艾滋病检测中心复筛确诊的52例HIV感染者的流行病学资料及部分临床资料.结果 筛查对象以30～39岁年龄段的阳性检查率为最高,确诊的52例HIV感染/艾滋病患者男女之比为4.2∶1;家政服务及待业人员18例占34.62％,民工13例占25％,驾驶员10例占19.23％;外省市户籍35例占67.31％,上海市户籍17例占32.69％.感染途径中异性性传播23例占44.23％,其次是男男同性恋14例占26.92％; HIV感染合并梅毒11例,艾滋病期合并梅毒2例.艾滋病期临床表现以发热、外周血细胞减少、肺部感染为主.结论 综合性医院诊断的HIV感染/艾滋病患者中,感染途径以性传播为主,艾滋病患者的临床表现无特异性,外省市户籍及低教育水平人群的HIV感染需引起临床医生重视.     

艾滋病与性传播疾病的关系

HIV /AIDS(获得性免疫缺陷综合征)与STD(性传播疾病)已成为全球性的重大公共卫生问题。一方面,HIV感染的流行极大的改变了STD的研究领域,且HIV /AIDS患者免疫功能的缺陷还使与之相关的STD的发生、发展及临床呈现出特殊的表现;另一方面,STD引起的GUD等疾病又可以促进HIV的感染与传播。本文就近几年有关艾滋病与STD的相关性研究作一综述。关键词:艾滋病;人类免疫缺陷病毒;性传播疾病。     

AIDS and prevalence of antibody to human immunodeficiency virus (HIV) in high risk groups in Thailand.

Since September 1984, six cases of acquired immune deficiency syndrome (AIDS) and 11 cases of AIDS related complex (ARC) have been reported in Thailand. All people with AIDS were homosexual or bisexual men; two were Thai and the rest were European or American. Nine of the 11 people with ARC were homosexual or bisexual men, one was the female sexual partner of a man with AIDS, and one was a Thai man who had lived in the United States of America for several years, but denied having had any homosexual contact. Nine of the 11 people with ARC were Thai. In a survey in April 1985 at a resort area near Bangkok, antibodies to human immunodeficiency virus (HIV) (confirmed by western blot) were detected in 2.4% of 127 homosexual men and none of 77 female prostitutes. In a more extensive survey in October 1985, antibodies were detected in 0.8% of 720 homosexual men, but none of 2880 female prostitutes or 309 sexually active heterosexual men. HIV has been introduced into Thailand primarily by homosexual transmission. The public health policy of Thailand concerning AIDS is discussed.     

Dermatological management of human immunodeficiency virus (HIV)

Atypical presentations of typical dermatological conditions are common in human immunodeficiency virus (HIV). This article will focus on three specific topics: eosinophilic folliculitis, psoriasis, and cutaneous mycoses. Their unique presentations in HIV and treatments are discussed.     

Dermatological manifestations of human immunodeficiency virus infected / acquired immunodeficiency syndrome patients in a referral hospital of Central Kerala

A number of skin diseases are described in association with HIV infection/AIDS. In the present study the frequency of various skin manifestations among HIV infected / AIDS patients are noted. Generalised pruritus and dry skin were the common manifestations encountered. There was a significant absence of Kaposi's sarcoma, multi-dermatomal herpes zoster and oral hairy leukoplakia. A prominent hyperpigmented band on finger nails was seen.