Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Mucocutaneous Manifestation of HIV and the Correlation with CD4 Count and Viral Load: A Prospective Study from Turkey
HIV'in Mukokutanöz Bulguları ve CD4 Sayısı ile Viral Yük Arasındaki Korelasyon: Türkiye'den Prospektif Bir Çalışma
Rıdvan GÜNEŞa, Seray KÜLCÜ ÇAKMAKa, Ahu YORULMAZa
aDepartment of Dermatolog, University of Health Sciences Ankara Numune Hospital, Ankara, TURKEY
Turkiye Klinikleri J Dermatol. 2020;30(3):88-94
doi: 10.5336/dermato.2020-79035
Article Language: EN
Full Text
ABSTRACT
 Objective: From the first reported cases in the early 1980s, Human Immunodeficiency Virus (HIV) infection has been a major global health concern. Although currently the infection is considered to consolidate in areas of severe social and economic distress, recent data on the epidemiology of HIV reveals that more than 36 million people live with HIV globally. HIV has a wide range of mucocutaneous manifestations, some of which are hallmark presentations of the infection. The aim of the present study is investigate the mucocutaneous manifestations in HIV-positive patients and their relationship with CD4-cell count and viral load. Material and Methods: A total of 105 consecutive HIV-positive patients (94 men, 11 women) were prospectively enrolled. Detailed information about patients' demographic and clinical characteristics such as medical history, physical examination, laboratory evaluation, CD4- cell count and HIV RNA levels were recorded. Chi-square, Mann Whitney-U and Kruskal-Wallis tests were used for statistical analysis, with a significance threshold of p<0.05. Results: At least one mucocutanoues manifestation was detected in 82.9% of the patients. The most common mucocutanoues disorders were oral candidiasis (29%), xerosis cutis (23%), tinea pedis 18%), onychomycosis (14%) and seborrheic dermatitis (13%). Other sexually transmitted diseases were seen in 24.8% of the patients. There were not significant associations between the gender, CD4-cell count, HIV RNA copy count, treatment status and presence of mucocutaneous manifestations (p=0.454, p=0.543, p=0.850, p=0.125, respectively). On the other hand, the mean age and duration of HIV infection was significantly higher in patients with at least one mucocutaneous manifestation (p<0.05). Conclusion: This is the first prospective study from Turkey to address the mucocutaneous manifestations in HIV-infected patients. In our study, we found that the majority of patients with HIV infection had at least one mucocutaneous manifestation, the most common of which was oral candidiasis. Although further studies are needed to validate our assumption, our findings suggest that mucocutaneous manifestations might be indicators of HIV infection in our country.

Keywords: HIV; mucocutaneous manifestation; CD4- cell count; viral load
ÖZET
 Amaç: İlk vakalarının bildirildiği 1980'li yılların başından bugüne kadar geçen süre zarfında, İnsan İmmün Yetmezlik Virüsü [Human Immunodeficiency Virus (HIV)] majör bir global sağlık tehdidi olmuştur. Her ne kadar günümüzde enfeksiyon şiddetli sosyo-ekonomik sıkıntıların yaşandığı bölgelere konsolide olmuş olsa da, HIV epidemiyoloji ile ilgili güncel veriler global düzeyde 36 milyondan fazla insanın enfekte olduğunu ortaya koymaktadır. HIV enfeksiyonu oldukça geniş yelpazede ortaya çıkan mukokutanöz bulgulara sahiptir ve bunların bazıları hastalığa damga vuran prezentasyonlardır. Bu çalışmanın amacı HIV enfekte olguların mukokutanöz bulgularını ve bu bulguların CD4 hücre sayısı ve viral yükle olan ilişkisinin araştırmaktır. Gereç ve Yöntemler: Bu çalışmada ardışık 105 (94 erkek, 11 kadın) HIV pozitif olgu prospektif olarak değerlendirilmiştir. Hastaların tıbbi hikaye, fizik muayene, laboratuvar bulguları, CD4 sayıları ve HIV RNA düzeyleri gibi demografik ve klinik özelliklerini içeren ayrıntılı bilgileri kaydedildi. İstatiksel analizde Ki-kare, Mann Whitney-U ve Kruskal-Wallis testleri kullanıldı, 0,05'in altında olan p değerleri anlamlı olarak kabul edildi. Bulgular: Hastaların %82,9'unda en az bir mukokutanöz bulgu tespit edildi. En sık patolojiler oral kandidiyazis (%29), kserosis kutis (%23), tinea pedis (%18), onikomikoz (%14) ve seboreik dermatitti (%13). Hastaların %28,4'ünde diğer cinsel yolla bulaşan hastalıklar görüldü. Cinsiyet, CD4 sayıları, HIV RNA düzeyleri, tedavi durumu ve mukokutanöz bulgu mevcudiyeti arasında herhangi bir korelasyon saptanmadı (p=0,454, p=0,543, p=0,850, p=0,125, sırasıyla). Ancak, ortalama yaş ve HIV enfeksiyonu süresi, en az bir mukokutanöz bulgusu olan hastalarda belirgin olarak daha yüksekti (p<0,05). Sonuç: Bu çalışma Türkiye'de HIV enfeksiyonu tanısı olan olgularda mukokutanöz bulguları araştıran ilk prospektif çalışmadır. Bu çalışma ile HIV pozitif olguların büyük çoğunluğunda en sık olanın oral kandidiyazis olduğu, en az bir mukokutanöz bulgu geliştiğini ortaya koymuş olduk. Her ne kadar, hipotezimizin doğruluğunu kanıtlayacak ileri çalışmalara ihtiyaç olsa da, bu sonuç ülkemizde mukokutanöz bulguların HIV enfeksiyonunun göstergeleri olabileceği fikrini gündeme getirmektedir.

Anahtar Kelimeler: HIV; mukokutanöz bulgular; CD4 hücre sayısı; viral yük
REFERENCES:
  1. Rane SR, Agrawal PB, Kadgi NV, Jadhav MV, Puranik SC. Histopathological study of cutaneous manifestations in HIV and AIDS patients. Int J Dermatol. 2014;53(6):746-51.[Crossref] [PubMed] 
  2. Altuntaş Aydın Ö, Kumbasar Karaosmanoğlu H, Korkusuz R, Özeren M, Nazlican Ö. Mucocutaneous manifestations and the relationship to CD4 lymphocyte counts among Turkish HIV/AIDS patients in İstanbul, Turkey. Turk J Med Sci. 2015;45(1):89-92.[Crossref] [PubMed] 
  3. Azfar NA, Khan AR, Zia MA, Humayun A, Malik LM, Jahangir M, et al. Frequency of mucocutaneous manifestations in HIV positive Pakistani patients. J Pak Assoc Dermatol. 2011;21:149-53.[Link] 
  4. Singh H, Singh P, Tiwari P, Dey V, Dulhani N, Singh A, et al. Dermatological manifestations in HIV-infected patients at a tertiary care hospital in a tribal (Bastar) region of Chhattisgarh, India. Indian J Dermatol. 2009;54(4):338-41.[Crossref] [PubMed] [PMC] 
  5. Freytes DM, Arroyo-Novoa CM, Figueroa-Ramos MI, Ruiz-Lebrón RB, Stotts NA, Busquets A, et al. Skin disease in HIV-positive persons living in Puerto Rico. Adv Skin Wound Care. 2007;20(3):149-50,152-6.[Crossref] [PubMed] 
  6. Chawhan SM, Bhat DM, Solanke SM. Dermatological manifestations in human immunodeficiency virus infected patients: Morphological spectrum with CD4 correlation. Indian J Sex Transm Dis AIDS. 2013;34(2):89-94.[Crossref] [PubMed] [PMC] 
  7. Organization WH. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV- related disease in adults and children Switzerland: Organization; 2007.[Link] 
  8. Osborne GE, Taylor C, Fuller LC. The management of HIV-related skin disease. Part I: infections. Int J STD AIDS. 2003;14(2):78-86.[Crossref] [PubMed] 
  9. Cedeno-Laurent F, Gómez-Flores M, Mendez N, Ancer-Rodríguez J, Bryant JL, Gaspari AA, Trujillo JR. New insights into HIV-1-primary skin disorders. J Int AIDS Soc. 2011;24;14:5.[Crossref] [PubMed] [PMC] 
  10. Huang XJ, Li HY, Chen DX, Wang XC, Li ZC, Wu YS, et al. Clinical analysis of skin lesions in 796 Chinese HIV- positive patients. Acta Derm Venereol. 2011;91(5):552-6.[Crossref] [PubMed] 
  11. Vasudevan B, Sagar A, Bahal A, Mohanty A. Cutaneous manifestations of HIV-a detailed study of morphological variants, markers of advanced disease, and the changing spectrum. Med J Armed Forces India. 2012;68(1):20-7.[Crossref] [PubMed] [PMC] 
  12. Dwiyana RF, Rowawi R, Lestari M, Alisjahbana B, van der Ven AJ, Djajakusumah TS, et al. Skin disorders in HIV-infected patients from West Java. Acta Med Indones. 2009;41 Suppl 1:18-22.[PubMed] 
  13. Kore SD, Kanwar AJ, Vinay K, Wanchu A. Pattern of mucocutaneous manifestations in human immunodeficiency virus-positive patients in North India. Indian J Sex Transm Dis AIDS. 2013;34(1):19-24.[Crossref] [PubMed] [PMC] 
  14. Chandrakala C, Parimalam K, Wahab AJ, Anand N. Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study. Indian J Sex Transm Dis AIDS. 2017;38(2):128-35.[Crossref] [PubMed] [PMC] 
  15. de Vries HJ. Skin as an indicator for sexually transmitted infections. Clin Dermatol. 2014;32(2):196-208.[Crossref] [PubMed] 
  16. Huang K, Chen A, Zhang X, Song Z, Xu H, Cao J, et al. Progranulin is preferentially expressed in patients with psoriasis vulgaris and protects mice from psoriasis-like skin inflammation. Immunology. 2015;145(2):279-87.[Crossref] [PubMed] [PMC] 
  17. Ertunc B, Kaya S, Koksal I. Clinico-epidemiological analysis of HIV/AIDS patients. Eurasian J Med. 2016;48(3):157-61.[Crossref] [PubMed] [PMC] 
  18. Nilesh Morar, FCDerm Mm, Ncoza C. Dlova, FCDerm Mm, Anisa Mosam Fcd, Jamila Aboobaker Fcd. Cutaneous manifestations of HIV in Kwa-Zulu Natal, South Africa. Int J Dermatol. 2006;45:1006-7.[Crossref] [PubMed] 

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