Patterns of skin manifestations and their relationships with CD4 counts among HIV/AIDS patients in Cameroon

Abstract

Background: Skin manifestations are common clinical features among HIV/AIDS-positive patients. Their frequencies, patterns and associated factors have been shown to vary from region to region. The present study is aimed at documenting skin manifestations and their relationships with CD4 cell counts among HIV/AIDS patients in Cameroon.

Methods: This study lasted for 16 months (from September 2001 to December 2002). After informed consent, data on skin disorders, HIV status, CD4 and viral load were obtained by physical examination and laboratory methods.

Results: Of the 384 subjects studied, 236 (61.5%) were females and 148 (38.5%) were males. Up to 264 (68.8%) patients presented with at least one type of skin problem. Generalized prurigo, oral candidiasis, herpes zoster, and vaginal candidiasis were the most common skin problems. Mean CD4 cell count (128 +/- 85 cells/mm(3)) and mean viral load (79,433 copies/mL) in patients with herpes zoster were higher (P < 0.001). Patients with oral candidiasis and vaginal candidiasis had significantly lower (109 +/- 127 cells/mm(3), P < 0.02) and higher (131 +/- 85 cells/mm(3), P < 0.05) mean CD4 cell counts, respectively. Prurigo was associated with higher mean viral load (31,623 +/- 20 copies/mL, P < 0.04). Viral lesions were associated with high mean CD4 cell count (123 +/- 83 cells/mm(3), P < 0.001). Kaposi's sarcoma and parasitic lesions (crusted scabies) were both, respectively, associated with lower mean CD4 cell counts [(78 +/- 66 cells/mm(3), P < 0.001) (6 +/- 0 cells/mm(3), P < 0.04)].

Conclusion: We conclude, first that skin problems are common in HIV-infected individuals in Cameroon and that patients with advanced stages of these problems have relatively very low mean CD4 cell counts. Second, that mucocutaneous disorders like vaginal candidiasis and herpes zoster occur early in HIV infection while Kaposi's sarcoma is common in advanced HIV infection.