Correlation of mucocutaneous manifestations of HIV/AIDS infection with CD4 counts and disease progression

Abstract

Background: As the search for reliable clinical indicators for management of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in resource-poor settings continues, mucocutaneous disorders of HIV should be considered among key clinical indicators for prediction of underlying immune status, disease progression, and possible complications of highly active antiretroviral therapy in Africa.

Objective: To identify and correlate mucocutaneous disorders to CD4-positive cell count and total lymphocyte count in HIV/AIDS patients of southeast Nigeria.

Methodology: Data were collected through interview-administered survey followed by clinical and dermatological examination of recruited patients and controls.

Result: Mean CD4 cell count of HIV/AIDS patients was 303.81 cells/mm(3) and was significantly lower to the control group - 807.3 cells/mm(3) (z = 10.089 and P < 0.005). In comparison with the CD4 cell count of asymptomatic HIV-positive patients (mean 433.6 cells/mm(3)), CD4 cell count of HIV-positive patients with various mucocutaneous manifestations (mean 293.63 cells/mm(3)) was statistically correlated with low counts (z = 4.0731 and P < 0.05). Papulopruritic itch accounted for 32.2% (73/227) among patients with CD4+ cell counts of 51-200 cells/mm(3), while seborrheic dermatitis occurred most significantly with CD4 cell counts of 201-500 cells/mm(3) (43.1% vs. 12%P < 0.01) relative to those with lower CD4+ counts (51-200 cells/mm(3)). Mucocutaneous lesion counts of >100 cells/mm(3) were readily observed in advanced stage.

Conclusion: Cryptococcus skin lesions occurred at low CD4+ counts of </= 50 cells/mm(3); Kaposi sarcoma at CD4+ counts of </= 200 cells/mm(3), while seborrheic dermatitis occurred at CD4+ counts of >200 cells/mm(3 )and as an early skin manifestation within our environment. Campaign for the skin as an important clinical organ for assessment, prediction of immune status, and management of HIV/AIDS, particularly for hard-to-reach and resource-limited health facilities, has to be undertaken.