The acquired immune deficiency syndrome (AIDS) is caused by human immune deficiency virus (HIV) infection,
damaging the cell mediated immune system.
Skin is the most commonly
affected organ in HIV infection. Cutaneous lesions in HIV positive
patients serve as a marker of HIV infection and also indicates the stage
of the disease.
Opportunistic infection patterns are different in different parts of the
world and change as people migrate.
'Highly active antiretroviral therapy' (HAART) was introduced in 1997.
Opportunistic infections in HIV positive patients have decreased since
introduction of the therapy. Following therapy there is fall in viral titre and increase in CD4 cells. The cutaneous conditions improve or decline in incidence after the therapy.
Infectious diseases in AIDS
Virus related lesions in AIDS:
In HIV- positive patients this lesion presents as persistent umbilicated
or verrucous papules, commonly on the head and neck region.
reveals cup-shaped lesion containing molluscum bodies.
Giant and warty verrucous mollusca contagiosa are markers of advanced HIV infection.
Usually occurs in perianal, genital and orofacial skin.
In HIV and HSV
coinfection the lesions last for more than one month.
reveals numerous intranuclear and intracytoplasmic nuclear inclusions.
Extensive ulceration and intraepidermal acantholytic vesicles are noted.
Varicela zoster virus infection
Clues to HIV and VZV coinfection
- The lesions usually occur in younger patients. These are more severe
lesions and of longer duration.
Human papillomavirus infection
There is a high incidence of common and anogenital wart in HIV positive
Condylomata acuminata may occur in HIV infected homosexual men.
There is risk of dysplasia in perianal condyloma.
Grossly, these lesions
may present as smooth sessile plaques to exophytic cauliflower plaques.
Verrucae vulgaris, multiple plantar warts, flat and filiform
warts may be noted in HIV infected patients.
Common warts are
frequently present on the bearded area of the face in HIV
Cytomegalovirus: Almost 90% HIV positive patients develop
Histological examination reveals Cytomegalovirus inclusions in endothelial cells and fibroblasts together with areas of
Oral hairy leukoplakia: Poorly defined projections are noted on the
lateral borders of the tongue.
This lesion indicates advanced
Causative organisms include Epstein-Barr virus, human papillomavirus or candida.
Histological examination reveals some acanthosis and parakeratosis.
Large pale staining cells resembling keratinocytes are present.
|Viral, bacterial, fungal and parasitic infections may occur alone or in combination with each other.
infected patients, fungal disorders may present as disseminated or localised disorders.
Cryptococcosis , sporotrichosis and
candidiasis are common in AIDS patients.
Staphylococcus aureus is the most
common bacterial pathogen identified in HIV- infected patients.
Numerous non-tuberculous mycobacteria may cause cutaneous lesions in HIV positive
These lesions display a range of histological features ranging
from suppurative to granulomatous inflammmation.
Histological Features in Inflammatory Dermatosis in HIV-Positive Patients
1. Neutrophils and eosinophils in the inflammatory infiltrate are
increased in number.
2. Plasma cells are present.
3. Apoptotic keratinocyte may be present
4. T-cells negative for CD7 are increased in the inflammatory infiltrate.
5. Increased number of CD30 positive cells appear in the inflammatory
6. Histological examination of papular eruptions in HIV positive patients
reveal superficial perivascular infiltrate of lymphocytes and some
Dermal fibrosis and features of early necrobiosis are often present.
- In HIV positive patients,
lichen planus (hypertrophic)
is widely distributed involving face and extremities.
There is extensive
epidermal hyperkeratosis, acanthosis, hypergranulosis and a dense lichenoid inflammatory infiltrate.
- Seborrheic dermatitis is characterized by dermal perivascular acute
inflammatory infiltrate and keratinocyte necrosis.
- HIV associated eosinophilic folliculitis is usually noted in the last
stage of HIV disease.
There is follicular spongiosis together with
infiltration of eosinophils and lymphocytes.
Flame figures and eosinophil
degranulation may be noted in the dermis.
- Chronic actinic dermatitis is characterized by psoriasiform epidermal hyperplasia and interphase dermatitis.
Necrotic keratinocytes and
eosinophils are present. This lesion may indicate advanced HIV infection.
may be noted in HIV positive patients taking
These lesions are characterized by vacuolar
degeneration of basal layer, dermal inflammation , pigment incontinence
and necrotic keratinocytes.
List of bacterial lesions in patients with
infections- (Mycobacteium avium-intracellulare
, Mycobacterium Kansasii, Mycobacterium haemophilum, Mycobacterium marinum etc)
Staphylococcus pyogenes ; Syphilis
List of fungal lesions in patients with
Protozoal infection AIDS:
Arthropod related lesions:
The following cutaneous lesions are noted
in patients with AIDS:
Seborrheic dermatitis ;
- Psoriasis vulgaris ;
- Hypertrophic lichen planus
- Contact dermatitis ;
HIV associated photosensitivity;
Cutaneous drug eruption ;
Neoplasms related to AIDS are as follows:
Kaposi's Sarcoma: Epidemic
(HIV associated) Kaposi's Sarcoma
- Cutaneous lymphoma :
Bowen's disease :
Squamous cell carcinoma :
Basal cell carcinoma:
AIDS related malignant tumors