Cutaneous Lesions Associated with AIDS
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. In many developing countries HAART is still not widely available.
Molluscum contagiosum: In HIV- positive patients this lesion presents as persistent umbilicated or verrucous papules, commonly on the head and neck region. Histopathology reveals cup-shaped lesion containing molluscum bodies. Giant and warty verrucous mollusca contagiosa are markers of advanced HIV infection.
Herpes Simplex Usually occurs in perianal, genital and orofacial skin. In HIV and HSV coinfection the lesions last for more than one month. Histopathology reveals numerous intranuclear and intracytoplasmic nuclear inclusions. Extensive ulceration and intraepidermal acantholytic vesicles are noted . Image
Human papillomavirus infection There is a high incidence of common and anogenital wart in HIV positive patients. 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 positive patients. Image1 ; Image2 .
Cytomegalovirus: Almost 90% HIV positive patients develop CMV infection. Histological examination reveals CMV inclusions in endothelial cells and fibroblasts together with areas of epidermal necrosis . Image Link1 (Univ. of Washington) ; Image Link2 (pathguy.com)
Oral hairy leukoplakia: Poorly defined projections are noted on the
lateral borders of the tongue.This lesion indicates advanced
immunosuppression. 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.
HISTOLOGICAL FEATURES IN INFLAMMATORY
DERMATOSIS IN HIV-POSITIVE PATIENTS:
infections- (Mycobacteium avium-intracellulare
, M. Kansasii, M.
haemophilum, M. marinum etc)
Scabies : Image
Seborrheic dermatitis ;
Psoriasis vulgaris ;
Hypertrophic lichen planus
DermAtlas ; Eosinophilic folliculitis;
Contact dermatitis ;
Kaposi's Sarcoma: Epidemic
(HIV associated) Kaposi's Sarcoma
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