Vitiligo in association with human immunodeficiency virus infection

Autoimmune disorders such as vitiligo have been previously reported in patients with human immunodeficiency virus (HIV) infection. We describe a case of vitiligo in association with HIV where a rising CD4 lymphocyte count due to highly active antiretroviral therapy (HAART) closely correlated with changes in the skin. This effect, to our knowledge, has not been previously observed.     

Eosinophilic pustular folliculitis: the first case associated with hepatitis C virus

Eosinophilic pustular folliculitis is a rare disorder that is characterized by recurrent crops of papules and pustules localized on seborrheic areas of the body. The etiopathogenesis of the disease is still unknown, but it has been related to infections and immunosuppressive states. This report is the first case to be found to be related to hepatitis C virus infection.     

Eosinophilic pustular folliculitis: The transition in sex differences and interracial characteristics between 1965 and 2013

Eosinophilic pustular folliculitis (EPF) is characterized by a non‐infectious infiltration of eosinophils in the hair follicles. It has three variants: (i) classic EPF; (ii) immunosuppression‐associated EPF, which herein is subdivided into HIV‐associated (IS/HIV) and non‐HIV‐associated (IS/non‐HIV); and (iii) infancy‐associated EPF (I‐EPF). The rarity of EPF has hindered our understanding of this entity. To examine the characteristics of EPF, with respect to age, sex, race, and chronology, published in case reports to date, we queried PubMed using the following terms: (“eosinophilic pustular folliculitis” [All Fields] OR “eosinophilic folliculitis” [All Fields]) AND (“1965/1/1” [PDAT]: “2013/12/31” [PDAT]). Additional Japanese cases were collected from Igaku Chuo Zasshi through Ichushi‐Web, JDream III, and secondhand quotations from domestic periodicals published in Japan. Proceedings were excluded. The PubMed search produced 275 citations containing 358 cases of EPF (224 men, 132 women, and two of unspecified sex); these cases involved classic EPF (101 Japanese and 81 non‐Japanese), IS/HIV (4 Japanese and 85 non‐Japanese), IS/non‐HIV (4 Japanese and 20 non‐Japanese), and I‐EPF (4 Japanese and 59 non‐Japanese). Ichushi generated an additional 148 citations containing 207 cases of Japanese (148 men and 59 women), which included cases of classic EPF (181 cases), IS/HIV (14 cases), IS/non‐HIV (9 cases), and I‐EPF (3 cases). There was no sex difference in the classic EPF cases reported between 2003 and 2013, whereas IS/HIV, IS/non‐HIV, and I‐EPF were predominated by men. There is room for reconsideration of sex differences, particularly with regard to classic EPF. The rarity and specificity of I‐EPF in Japan may reflect a state of uncertainty about this entity.     

Eosinophilic pustular folliculitis: A proposal of diagnostic and therapeutic algorithms

Eosinophilic pustular folliculitis (EPF) is a sterile inflammatory dermatosis of unknown etiology. In addition to classic EPF, which affects otherwise healthy individuals, an immunocompromised state can cause immunosuppression‐associated EPF (IS‐EPF), which may be referred to dermatologists in inpatient services for assessments. Infancy‐associated EPF (I‐EPF) is the least characterized subtype, being observed mainly in non‐Japanese infants. Diagnosis of EPF is challenging because its lesions mimic those of other common diseases, such as acne and dermatomycosis. Furthermore, there is no consensus regarding the treatment for each subtype of EPF. Here, we created procedure algorithms that facilitate the diagnosis and selection of therapeutic options on the basis of published work available in the public domain. Our diagnostic algorithm comprised a simple flowchart to direct physicians toward proper diagnosis. Recommended regimens were summarized in an easy‐to‐comprehend therapeutic algorithm for each subtype of EPF. These algorithms would facilitate the diagnostic and therapeutic procedure of EPF.     

Peculiar vegetative tumor-like genital herpes simplex nodules with brisk tissue eosinophilia in patients with human immunodeficiency virus infection

Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.     

HIV感染实验室诊断技术进展

人类免疫缺陷病毒(HIV)感染严重威胁人类健康,提高HIV感染的检出率具有重要的流行病学及临床意义。本文对HIV感染的实验室检测技术进行了综述,并着重介绍了近年飞速发展的各种分子生物学技术在缩短HIV感染窗口期方面的应用。     

Detection and typing of human papillomavirus in cutaneous warts of patients infected with human immunodeficiency virus type 1

BACKGROUND: Cutaneous warts are caused by human papillomavirus (HPV). To date, more than 120 different types of HPV are known, of which 80 have been completely characterized. Prevalence studies on types of HPV present in cutaneous warts have been carried out in immunocompetent individuals and immunosuppressed organ allograft recipients, but not in human immunodeficiency virus (HIV)-positive patients. OBJECTIVES: To determine the HPV types present in cutaneous warts of HIV-infected patients. METHODS: Twenty-five biopsies of cutaneous warts from HIV-infected patients and 14 samples from control non-HIV-infected patients were studied. HPV detection was performed by polymerase chain reaction using two sets of primers: MY09/MY11 and RK91. The type of HPV was determined by restriction fragment length polymorphism analysis and direct sequencing of the amplified products. RESULTS: HPV DNA was detected in 64% of cutaneous warts from HIV-infected patients and in 79% of samples from the control group. The HPV types identified in HIV-infected patients were: HPV 2 (38%), 57 (31%), 27 (12%), 6 (12%) and 7 (6%). HPV 2/27/57 predominated in both groups, being present in 81% of lesions from HIV-infected patients and 82% of samples from non-HIV-infected patients. HPV 6, a genital HPV type rarely found in cutaneous lesions, was detected in two warts from HIV-infected patients and in one lesion of the immunocompetent group. HPV 7, characteristically associated with butcher's warts, and recently detected in oral and perioral lesions of HIV-infected patients, was found for the first time in a non-facial lesion of an HIV-infected patient. CONCLUSIONS: This is the first study evaluating the prevalence of HPV types in cutaneous warts of HIV-infected patients and immunocompetent individuals in Brazil.     

Update on kidney transplantation in human immunodeficiency virus infected recipients

Improved survival of human immunodeficiency virus (HIV) infected patients with chronic kidney disease following the introduction of antiretroviral therapy resulted in the need to revisit the topic of kidney transplantation in these patients. Large cohort studies have demonstrated favorable outcomes and proved that transplantation is a viable therapeutic option. However, HIV-infected recipients had higher rates of rejection. Immunosuppressive therapy did not negatively impact the course of HIV infection. Some of the immunosuppressive drugs used following transplantation exhibit antiretroviral effects. A close collaboration between infectious disease specialists and transplant professionals is mandatory in order to optimize transplantation outcomes in these patients. Transplantation from HIV⁺ donors to HIV⁺ recipients has been a subject of intense debate. The HIV Organ Policy Equity act provided a platform to research this area further and to develop guidelines. The first HIV⁺ to HIV⁺ kidney transplant in the United States and the first HIV⁺ to HIV⁺ liver transplant in the world were recently performed at the Johns Hopkins University Medical Center.     

Status of histoid leprosy--a clinical, bacteriological, histopathological and immunological appraisal

The study of different aspects, namely clinical, bacteriological, histopathological and immunological, of 23 cases of histoid leprosy were quite revealing. The salient features included the occurrence of histoid lesions in a proportion of untreated leprosy patients in addition to those on dapsone treatment for a variable periods of time, a high bacteriological index in spite of infrequent formation of globi, high morphological indices and the immunological status of these patients. Cell-mediated immunity, which was deficient in relation to healthy controls, appeared to be augmented when compared with active lepromatous (LL) patients. A few contributory factors to the development of such a situation are discussed.     

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.     

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。     

Epstein-Barr virus-associated leiomyosarcoma with cutaneous involvement in an African child with human immunodeficiency virus: a case report and review of the literature

Epstein-Barr virus (EBV)-associated smooth muscle tumors (SMTs) are infrequently encountered lesions restricted to immunocompromised patients. However, they represent the second most common tumor in children with human immunodeficiency virus (HIV) infection. We report a case of a progressively enlarging abdominal mass with cutaneous involvement in an HIV-infected, 4-year-old African girl in Malawi with clinical acquired immunodeficiency syndrome on highly active antiretroviral therapy. Analysis of an excisional specimen revealed a well-differentiated leiomyosarcoma and subsequent studies revealed diffuse nuclear positivity for Epstein-Barr virus early RNAs in lesional cells. We present a report of this case and provide a summary of the literature regarding SMTs in pediatric HIV-infected patients. In addition, we draw attention to the cutaneous manifestations of SMTs in immunosuppressed populations. We highlight EBV-related SMTs as a potential cutaneous complication of HIV infection in children and immunosuppressed patients populations as a whole.     

Skin disorders in Korean patients infected with human immunodeficiency virus and their association with a CD4 lymphocyte count: a preliminary study

Background Dermatological disorders are quite common in human immunodeficiency virus (HIV)‐infected patients. However, cutaneous findings in Korean HIV‐infected patients have not been properly investigated. Objective To investigate the spectrum of dermatological disorders in Korean HIV‐infected individuals according to a CD4 lymphocyte count. Methods A retrospective clinical study was carried out from June 2002 to January 2008. We comprehensively collected information regarding HIV‐associated skin problems, laboratory data and the history of highly active antiretroviral therapy (HAART). Results Ninety‐nine HIV‐seropositive patients (mean age: 39.6 ± 11.3 years, males: 94.9%) were included in this study. Of them, 55 patients (55.6%) presented with at least one skin problem. The four most common dermatological disorders were eosinophilic pustular folliculitis (18.6%), symptomatic syphilis (comprising of primary and secondary syphilis) (17.1%), seborrhoeic dermatitis (17.1%) and condyloma acuminatum (12.8%). The group with a CD4 lymphocyte count < 200 × 10⁶ cells/L showed a significantly higher prevalence of Kaposi sarcoma compared with the group with a CD4 lymphocyte count > 200 × 10⁶ cells/L (P = 0.014). Condyloma was more prevalent in the group with a CD4 count > 200 × 10⁶ cells/L (P = 0.022). The patients treated with HAART had a lower prevalence of neurosyphilis compared with the non‐treated group (P = 0.018). Conclusions Diverse dermatological conditions were demonstrated in Korean HIV‐infected patients. Kaposi sarcoma was associated with a low CD4 lymphocyte count, but condyloma was associated with a high CD4 lymphocyte count. The prevalence of syphilis in our study was higher than that of Western countries. HAART seemed to be associated with the low prevalence of neurosyphilis.     

African origins and chronic kidney disease susceptibility in the human immunodeficiency virus era

Chronic kidney disease(CKD) is a major public health problem worldwide with the estimated incidence growing by approximately 6% annually. There are striking ethnic differences in the prevalence of CKD such that, in the United States, African Americans have the highest prevalence of CKD, four times the incidence of end stage renal disease when compared to Americans of European ancestry suggestive of genetic predisposition. Diabetes mel itus, hypertension and human immunodeficiency virus(HIV) infection are the major causes of CKD. HIV-associated nephropathy(HIVAN) is an irreversible form of CKD with considerable morbidity and mortality and is present predominantly in people of African ancestry. The APOL1 G1 and G2 alleles were more strongly associated with the risk for CKD than the previously examined MYH9 E1 risk haplotype in individuals of African ancestry. A strong association was reported in HIVAN, suggesting that 50% of African Americans with two APOL1 risk alleles, if untreated, would develop HIVAN. However these two variants are not enough to cause disease. The prevailing belief is that modifying factors or second hits(including genetic hits) underlie the pathogenesis of kidney disease. This work reviews the history of genetic susceptibility of CKD and outlines current theories regarding the role for APOL1 in CKD in the HIV era.     

Comparative study of cutaneous leishmaniasis in human immunodeficiency virus (HIV)-infected patients and non-HIV-infected patients in French Guiana

BACKGROUND: Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. OBJECTIVES: To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV- patients with the forms of leishmaniasis commonly found in French Guiana. METHODS: A case-control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. RESULTS: Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV-Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0.02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0.02) than did HIV- subjects. The CD4+ lymphocyte counts exceeded 200 mm(-3) in all HIV+ patients at the time of the diagnosis with leishmaniasis. CONCLUSIONS: In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm(-3)) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV- subjects.     

Water,electrolytes, and acid-base alterations in human immunodeficiency virus infected patients

The clinical spectrum of human immunodeficiency virus (HIV) infection associated disease has changed significantly over the past decade, mainly due to the wide availability and improvement of combination antiretroviral therapy regiments. Serious complications associated with profound immunodeficiency are nowadays fortunately rare in patients with adequate access to care and treatment. However, HIV infected patients, and particularly those with acquired immune deficiency syndrome, are predisposed to a host of different water, electrolyte, and acid-base disorders (sometimes with opposite characteristics), since they have a modified renal physiology (reduced free water clearance, and relatively increased fractional excretion of calcium and magnesium) and they are also exposed to infectious, inflammatory, endocrinological, oncological variables which promote clinical conditions (such as fever, tachypnea, vomiting, diarrhea, polyuria, and delirium), and may require a variety of medical interventions (antiviral medication, antibiotics, antineoplastic agents), whose combination predispose them to undermine their homeostatic capability. As many of these disturbances may remain clinically silent until reaching an advanced condition, high awareness is advisable, particularly in patients with late diagnosis, concomitant inflammatory conditions and opportunistic diseases. These disorders contribute to both morbidity and mortality in HIV infected patients.     

Human immunodeficiency virus and leprosy: an update

Coinfection with human immunodeficiency virus (HIV) has a major effect on the natural history of many infectious diseases, particularly mycobacterial diseases. Early in the HIV epidemic, it was predicted that HIV infection would worsen leprosy outcomes, with more patients developing lepromatous disease, an impaired response to multidrug therapy and fewer reactions. However, studies on the epidemiologic and clinical aspects of leprosy suggest that the course of leprosy in coinfected patients has not been greatly altered by HIV. In contrast, initiation of antiretroviral treatment has been reported to be associated with activation of subclinical Mycobacterium leprae infection and exacerbation of existing leprosy lesions. With regular new discoveries about the interaction of leprosy and HIV, the need to maintain research in this field is of considerable importance.     

Ivermectin alone or in combination with benzyl benzoate in the treatment of human immunodeficiency virus-associated scabies

In order to establish a safe and reliable treatment for human immunodeficiency virus (HIV)-associated scabies, we have treated 60 episodes of scabies in this setting, occurring in 39 patients, with one of the following regimens: (i) topical treatment with benzyl benzoate solution; (ii) single-dose oral treatment with ivermectin alone; and (iii) combination therapy with benzyl benzoate solution and oral ivermectin, employing the same regimens as single-agent therapy. Patients were stratified according to the severity score of the disease and the outcome (eradication, relapse, failure). We found that both benzyl benzoate and ivermectin alone were quite effective in mild to moderate scabies, but they were both associated with an unacceptable rate of relapse and failure in severe or crusted scabies. In contrast, combined treatment produced an optimal rate of success, without significant treatment-related side-effects. Therefore, we consider that combination treatment with benzyl benzoate solution and oral ivermectin is preferable to single-agent therapy in crusted scabies occurring in HIV/acquired immune deficiency syndrome patients.