Cutaneous manifestation of AIDS Human immunodeficiency virus HIV is lentivirus member of retroviral family two type HIV1 ampHIV2 Its RNA with Reverse transcriptase enzyme This virus infected ID: 777471
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DR .Anwar Issa Hasan 13/12/2018
Cutaneous manifestation of AIDS
Slide2Human immunodeficiency virus
HIV
: is lentivirus , member of retroviral family ,two type HIV1 &HIV2 .
Its RNA ,with Reverse transcriptase enzyme .
This virus infected
human CD4 T lymphocytes
,by attachment to the specific cell surface
(CCR5
) receptors & use human cellular DNA for replication .
Mode of transmission
: sexually transmitted disease ,but also can transmitted by all body fluid of infected persons , contaminated needles in IV drugs users , vertical transmissions from mother to her baby .
This virus cause
AIDS ( acquired immunodeficiency syndrome
).
Actively treated with
ART ( antiretroviral therapy
).
In HIV several cutaneous diseases (
disseminated coccidioidomycosis & Kaposi s sarcoma
) are AIDS defining conditions , whereas
Seborrheic dermatitis & oral hairy leukoplakia
can sever as clue for early diagnosis .
Slide3Slide4Cutaneous manifestation of HIV infection
Its depending on : stage of viral infection , viral load & CD4 T lymphocytes accounts.
Cutaneous manifestation are ;
Exanthem of primary HIV infection :
occurs after incubation periods of 3-6 weeks
Morbilliform eruption :appears in setting of peak viremia accompanied by orogenital ulceration , fever ,fatigue ,headache , pharyngitis , arthralgia , myalgia & GIT symptoms .
Decrease in circulating CD4 lymphocytes.
Rash last 4-5 days & constitutional symptoms last few days to few months.
Dx :PCR to detects viral RNA in serum of patient & P24 antigen in plasma.
Slide5Slide6Cutaneous manifestation of aids
Cutaneous manifestation of AIDS:
number of
cutaneous diseases that can point to HIV diagnosis ,usually sever , disseminated , may atypical presentations & reluctance to the treatments , including infections ,inflammatory diseases and neoplastic conditions .
Types of cutaneous disease depend on CD4 T lymphocytes accounts so we divided its into 2 stages
Manifestation of early stage
( CD4 T cell > 500 cell/mm3).
M
anifestation of late stage
(CD4 cell <200 cell/ mm3).
Slide7Manifestation of early stage
Acute retroviral syndrome
.
Oral hairy leukoplakia
: corrugated white plaques with hair like projections ,on the lateral aspec
t
of tongue ,asymptomatic , caused by EBV infection.
Candidiasis
: recurrent vaginal or oropharyngial candidiasis (oral thrush).
Psoriasis
: new onset or exacerbation of preexisting psoriasis ,sever ,may resistant to treatments.
Seborrheic dermatitis
: sever SD , involved face & scalp .
Herpes zoster
: sever , multidermatomal , atypical ,may associated with systemic complications e.g. hepatitis ,encephalitis & pneumonia .
Kaposi sarcoma
: disseminated ,typically involved mucosal membrane e.g. oral mucosa ,atypical with burse like lesions or large papules or ulcerative nodules or even verrocus ,may metastasis to GIT .
Eruptive atypical melanocytic nevi
&
melanoma
.
Slide8Manifestation of early stage
Oral hairy leukoplakia
Sever psoriasis in AIDS patient
Slide9Slide10Manifestation of late stage
Eosinophilic folliculitis
: itchy ,follicular papules with excoriation,
Distributed on head & upper trunk , culture negative &biopsy show dermal infiltration with eosinophil.
Opportunistic infections
:
Cutaneous tuberculosis & other mycobacterial infections.
Disseminated deep fungal infection e.g. Histopalsmosis ,cryptococcosis.
Botryomycosis.
Bacillary angiomatosis :due to grame negative bacilli called bartonella henselae & quintana.
Slide11Manifestation of late stage
Viral infections :herpes simplex virus ( Periorificial ,ulceration for one month duration), CMV perianal ulcer .
Aspergillosis
Giant molluscum : multiple large size papules ,involved face of adult person.
Acquired ichthyosis .
Major aphthosis(
aphthous
ulcers).
Non Hodgkin lymphoma .
Papular pruritic eruption.
Proximal white onychomycosis.:
Dermatophytes infection of nail plate.
Slide12Manifestation of late stage
Eosinophilic folliculitis
Major aphtous ulcer
Slide13Opportunistic infections
HSV
infection
Giant molluscum
Slide14Cutaneous manifestation of aids
Immune reconstruction inflammatory syndrome :
those disorders that can flare or worsen due to increase in ability to mount an inflammatory response following the institution of ART.
INFECTIONS:
viral ,bacterial ,Dermatophytes, mycobacterial & deep fungal .
Inflammatory disorders :
psoriasis ,eczema, AA, SD, sarcodosis & acne vulgaris.
Neoplasms:
Kaposi s sarcoma & non Hodgkin lymphoma .
Slide15Diagnosis of HIV infection
Diagnosis of HIV infection by serological detection of viral antigens or antibodies :
ELIZA: IgM or IgG .
Western blot test : IgG .
PCR : for viral RNA .
Viral culture .
Antigenic capture :for viral P24 OR gp 120 Ags.
Slide16ANTIRETROVIRAL THERAPY (art)
ART : usually include combination of two antiviral drug e.g. NRTI+nNRTI (typically tenofovir and Efavirenz), antiviral therapy classes are:
Nucleoside Reverse transcriptase inhibitors :Lamivudine & tenofovir.
nNRTI: Efavirenz.
Protease inhibitor: Indinavir.
CCR5 inhibitor : Maraviroc .
Fusion inhibitor :Enfuvirtide .
Integrase inhibitor :Raltegravir .
Slide17Thank you