Effect of antiretroviral therapy on mucocutaneous manifestations among Human Immunodeficiency Virus-infected patients in a tertiary care centre in South India

Abstract

Background: Human Immunodeficiency Virus (HIV) infection produces a wide range of infectious and noninfectious dermatoses which correlate with the degree of immunodeficiency. Since the introduction of highly active antiretroviral therapy (HAART), there has been a dramatic decrease in the incidence of HIV-associated dermatoses. However, HAART itself causes various cutaneous adverse drug reactions.

Aims: To assess the various mucocutaneous manifestations in HIV-infected individuals and its association with CD4 count and to assess the effect of HAART on mucocutaneous manifestations.

Materials and methods: Of the 170 patients recruited, 110 patients were previously diagnosed with HIV and were on follow-up. The rest 60 patients were newly diagnosed cases at recruitment, and these patients were followed up every month for mucocutaneous manifestations for a period of 6 months.

Results: Of the 170 patients screened, 69.41% patients had at least one mucocutaneous lesion at presentation. Fungal, viral, and bacterial infections were observed present in 17.6%, 10.6%, and 9.4% patients, respectively. There was a significant difference in the occurrence of candidal infections in the HAART versus non-HAART group (P = 0.0002). Candidiasis (P ≤ 0.0001) and human papillomavirus infection (P = 0.0475) occurred more commonly with CD4 count <200 cells/mm (3) . Among the noninfectious dermatoses, inflammatory dermatoses (17.6%) were more commonly observed at recruitment followed by adverse cutaneous drug reactions (16.5%) and neoplasms (5.3%).

Conclusion: HAART has significantly altered the patterns of mucocutaneous manifestations. The prevalence of both infectious and inflammatory dermatoses has come down. However, there is an increase in the incidence of adverse cutaneous drug reactions.

Keywords: Antiretroviral therapy; CD4 count; Human Immunodeficiency Virus infection; mucocutaneous manifestations.

Flow Diagram 1

Status of the Human Immunodeficiency Virus seropositive cases at the time of recruitment and follow-up

Figure 1

Chronic herpes simplex presenting as multiple vesicular and ulcerative lesions in perianal area

Figure 2

Secondary syphilis - multiple nodulo-ulcerative lesions distributed in trunk and extremities

Figure 3

(a) Zidovudine induced pigmentation affecting palms. (b) Zidovudine induced longitudinal melanonychia

Figure 4

(a) Zidovudine induced lichenoid eruption affecting buccal mucosa. (b) Resolution of oral lichenoid eruption after changing zidovudine to tenofovir