Page 339 - HIVMED_v21_i1.indb

Page 5 of 7 Original Research

and that the average number of skin disorders per patient acuminata were observed in four patients, one of whom had
was significantly higher in patients with a CD4+ cell count concomitant anal squamous cell carcinoma in situ. Anal cancer
20
less than 200 cells/μL. Although we did not record the (a human papillomavirus-related cancer) has been associated
clinical stage of our study participants, the demographic data with the duration of both immunodeficiency and viral
suggest a recovering immune profile in our study population. replication. As a result of increased life expectancy, cancer-
29
Most of our participants were taking ART (74%) and had a specific screening programmes in HIV-infected patients
CD4+ cell count above 200 (69%) at the time of the study. should be extended to include non-AIDS-defining cancers
such as anal cancer and keratinocyte cancer.
Non-infectious dermatoses were the most common group of
mucocutaneous manifestations in our study. Inflammatory Drug-related dermatoses were observed in 2% of our
dermatoses were the predominant non-infectious dermatoses. study population and included steroid-induced rosacea and
Inflammatory dermatoses in the setting of HIV tend to be zidovudine (AZT)-induced mucocutaneous hyperpigmentation.
chronic, atypical and difficult to treat and, therefore, In this study, no patients presented with severe cutaneous
frequently warrant referral to specialist centres where the adverse drug reactions such as Steven–Johnson syndrome, toxic
prevalence might be overestimated. This could explain why epidermal necrolysis or drug hypersensitivity syndrome.
inflammatory dermatoses related to HIV (namely, seborrheic International studies in the ART era have reported a prevalence
dermatitis, psoriasis, drug eruptions and erythroderma) of drug eruptions between 10% and 17%. 14,17,18 A study
were the most common dermatologic cause of admission in a performed in a tertiary hospital in Cape Town, South Africa,
South African study performed in the pre-ART era. However, found that most severe skin reactions resulting in admission
9
studies in the ART era have persistently shown the spectrum occurred during the first 2 months after combination ART
of skin diseases shift from infectious to non-infectious initiation. Nevirapine and pregnancy are also known to be
dermatoses. 17,18,22 strongly associated with severe skin reactions. Most of the
13
participants receiving ART had been on treatment for more than
In our study, the increased prevalence of inflammatory 1 year and all those receiving an NNRTI-based regimen were
dermatoses was mainly attributed to PPE (20%) and taking efavirenz and not nevirapine. This could explain
seborrheic dermatitis (6%). The reported prevalence of PPE in the absence of severe cutaneous adverse drug reactions in
the literature ranges from 11% to 46%. 5,23,24 Two Ugandan our study. None of the female participants was pregnant at
studies have suggested that PPE may be related to an the time of the current study. Lastly, patients presenting with
exaggerated immunological reaction to arthropod bites. 23,25 severe skin reactions mostly necessitate inpatient management
The prevalence of PPE in our study may be attributed to and referral to tertiary institutions and may not present
its chronicity, its association with increased levels of directly to a district-level health facility.
immunosuppression (one-third of our study population had
a CD4+ cell count below 200) and poor socio-economic Infectious dermatoses were observed in half of our
conditions, which predispose patients to arthropod bites. 5,18,21 study population and were encountered less frequently
than non-infectious dermatoses. Tinea corporis (8%) and
Seborrheic dermatitis (6%) was the second most common oral candidiasis (6%) were the two most common conditions
inflammatory dermatosis in our study. The prevalence in the infectious dermatoses group. Dermatophytosis
of seborrheic dermatitis has been reported to be 40% in (including tinea corporis, tinea faciei, tinea pedis and
HIV-positive patients and as high as 80% in acquired onychomycosis) is common in the setting of HIV and tends
immunodeficiency syndrome (AIDS) patients in comparison to occur as an early manifestation of immunosuppression
26
30
with 3% in the HIV-negative population. Studies from at higher CD4+ cell counts. Dermatophytosis was recorded
China, India and the United States of America performed in in 17% of our patients, which is in line with other studies
the ART era have reported low prevalence rates of seborrheic performed in the ART era reporting a prevalence between
dermatitis at 1.21%, 1.8% and 10.6%, respectively. 14,21,27 11.9% and 17.6%. 16,20,21
Likewise, the prevalence of seborrheic dermatitis in our
study is similar to that of the HIV-negative population and Although oral candidiasis was one of the most common
may be attributed to the influence of ART. dermatoses recorded in our study, its prevalence is low
compared with previous studies. The incidence of candidiasis
Neoplastic conditions were recorded in 5% of the study has been shown to increase with a CD4+ cell count below
population. Since the introduction of ART, the incidence of 200. 14,15 Kore et al. and Han et al. demonstrated a significant
AIDS-defining cancers (Kaposi’s sarcoma, non-Hodgkin’s decline in candidiasis in their study population after the
lymphoma and cervical cancer) has decreased, whereas the initiation of ART (20.8% vs. 11.5% and 64.04% vs. 16.6%). 14,20
relative frequency of non-AIDS-defining cancers has The majority of participants in our study were on ART and
28
increased. Basal cell carcinoma and squamous cell carcinoma had a CD4+ count above 200. These factors, together with an
comprise the keratinocyte carcinomas and are the most increased awareness and early treatment of oral candidiasis,
common malignancies worldwide in both the general could likely explain its low prevalence.
population and PLWH. The spectrum of neoplastic
5,29
conditions observed in this study comprised benign epidermal The mean age of our study participants was 40 years, which
neoplasms and keratinocyte carcinomas. Condylomata is approximately 6 years older than that previously recorded

http://www.sajhivmed.org.za 331 Open Access