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] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com