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Skin Manifestations Associated with HIV/AIDS

  • Márcia S. Zampese
  • Gabriela Czarnobay Garbin
  • Bruna Guerra Rech
Chapter

Abstract

There is a wide range of HIV/host interactions-related environments, and dermatologic disorders can be present in all situations. The skin and mucosa can be sensitive indicators of underlying immunosuppression, and mucocutaneous disorders are often the first manifestation of HIV infection and advancing immunodeficiency. Cutaneous disorders develop in more than 90% of HIV-infected persons at some time during the course of the illness; they have been a basic index for the presence and course of HIV infection as well as a challenging task because of the severe and recalcitrant nature of such conditions. The aim of this chapter is to enhance awareness and familiarize healthcare providers with the most frequent cutaneous manifestations associated with HIV and AIDS so that they can recognize the possibility of an underling HIV infection, recommend appropriate testing, and provide timely and suitable management for either disease.

Keywords

Acquired immunodeficiency syndrome AIDS-related opportunistic infections HIV Sexually transmitted diseases Sexually transmitted infections Skin diseases Skin manifestations IRIS Antiretroviral Infection Prevention Risk 

Notes

Glossary

Antigenemia

The condition of having an antigen present in the blood.

Cantharidin

An odorless, colorless terpenoid secreted by many species of blister beetles, including broadly in genus Epicauta, and in species Lytta vesicatoria (Spanish fly). Externally, cantharidin is a potent vesicant (blistering agent), exposure to which can cause severe chemical burns.

Dermoscopy

A noninvasive method that allows the in vivo evaluation of colors and microstructures of the epidermis, the dermoepidermal junction, and the papillary dermis not visible to the naked eye. These structures are specifically correlated to histologic features.

Dimorphic fungus

Fungi that exist either in yeast form or as mold (mycelial form) depending on environmental conditions, physiologic conditions of the fungus, or genetic characteristics.

Gomori methenamine silver

Used widely as a screen for fungal organisms and particularly useful in staining carbohydrates. It can be used to identify the yeast-like fungus Pneumocystis jiroveci, which causes a form of pneumonia called pneumocystis pneumonia (PCP) or pneumocystosis.

GUD (genital ulcer disease)

Located on the genital area, usually caused by a sexually transmitted disease (STD) such as genital herpes, syphilis, chancroid, or chlamydia trachomatis. Genital ulcers are not strictly a sign of an STD.

Immune reconstitution syndrome (IRIS)

Some people who start antiretroviral therapy (ART) encounter health problems even though their HIV comes under control. An infection that they previously had might return. In other cases, they develop a new disease. This is linked to improvements in the patients’ immune systems. The problems usually occur in the first 2 months after starting HIV therapy. It may occur in about 20% of people starting ART.

LNA-1 (latent nuclear antigen)

A Kaposi’s sarcoma (KS)-associated herpesvirus (KSHV) latent protein initially found by Moore and colleagues as a speckled nuclear antigen present in primary effusion lymphoma cells that reacts with antibodies from patients with KS. LNA-1 has been suspected of playing a crucial role in modulating viral and cellular gene expression. It is commonly used as an antigen in blood tests to detect antibodies in persons that have been exposed to KSHV.

Majocchi’s granuloma

Can be defined as a deep folliculitis due to a cutaneous dermatophyte infection.

Meglumine antimoniate (MG)

A medication used for treating leishmaniasis. It is manufactured by Aventis and sold as Glucantime in France and Brazil, and Glucantim in Italy. It belongs to a group of compounds known as the pentavalent antimonials. It is administered by intramuscular injection.

p24 antigen test

Detects the presence of the p24 protein of HIV (also known as CA), the capsid protein of the virus.

PCR techniques

Techniques used in molecular biology to amplify a single copy or a few copies of a piece of DNA across several orders of magnitude, generating thousands to millions of copies of a particular DNA sequence.

Periodic acid-Schiff (PAS)

A staining method used to detect polysaccharides such as glycogen, and mucosubstances such as glycoproteins, glycolipids, and mucins in tissues.

Phlebotomine sandflies

A subfamily of the family Psychodidae. In several countries, their common name is sand fly. The Phlebotominae include many genera of blood-feeding (hematophagous) flies, including the primary vectors of leishmaniasis and others.

Podophyllotoxin

A nonalkaloid toxin lignan extracted from the roots and rhizomes of podophyllum species. it is used on the skin as a topical treatment of external genital warts, caused by some types of the human papillomavirus (HPV), and other warts.

Sodium stibogluconate (SSG)

A medication used to treat leishmaniasis, only available for administration by injection. It belongs to the class of drugs known as the pentavalent antimonials, because they contain antimony in its oxidation state of 5. SSG is marketed under the name Pentostam, and is exceedingly phlebotoxic.

Superantigens

A class of antigens that cause nonspecific activation of T cells resulting in polyclonal T-cell activation and massive cytokine release. They are produced by some pathogenic viruses and bacteria, most likely as a defense mechanism against the immune system.

Warthin–Starry stain

A silver nitrate-based staining method (silver stain) used in histology. Warthin–Starry stains organisms dark brown to black, and the background light golden brown/golden yellow. This technique involves the argyrophilic reaction.

WHO (World Health Organization)

A specialized agency of the United Nations concerned with international public health. It was established on 7 April 1948 and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group.

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Suggested Reading and Consulting

  1. CDC Sexually Transmitted Diseases Treatment Guidelines 2015. Available at https://www.cdc.gov/std/tg2015/. Although the guidelines emphasize treatment, prevention strategies and diagnostic recommendations also are discussed. This comprehensive document can be the go-to reference for anyone who manages patients at risk for STDs.
  2. Crum-Cianflone NF, Wallace MR. Vaccination in HIV-infected adults. AIDS Patient Care STDs. 2014;28(8):397–410. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117268/ PubMedPubMedCentralCrossRefGoogle Scholar
  3. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. A detailed guideline for management of opportunistic infections in HIV-patients also provides useful information on significant pharmacokinetic interactions between antiretroviral agents for HIV and drugs used to treat or prevent opportunistic infections.
  4. Guidelines on the Treatment of Skin and Oral HIV-Associated Conditions in Children and Adults. Geneva: World Health Organization; 2014. Available at http://www.who.int/maternal_child_adolescent/documents/skin-mucosal-and-hiv/en/These guidelines provide a summary of the key evidence and practice recommendations on the diagnosis and treatment of the main skin and oral conditions in HIV-infected adults and children. The primary audience for these guidelines is health professionals who are responsible for providing care to children, adolescents and adults in settings with HIV, primarily where resources are limited.
  5. HIV Book. Hoffmann C, Rockstroh JK, editors. Available at https://hivbook.com. A freely accessible medical information on HIV treatment.
  6. HIV InSite. Available at http://hivinsite.ucsf.edu. Comprehensive, up-to-date information on HIV/AIDS treatment and prevention from the University of California San Francisco, USA.
  7. Liverpool HIV Drug Interactions website. Available at http://www.hiv-druginteractions.org/. A comprehensive, user-friendly, free drug interaction charts. It provides clinically useful, reliable, up-to date, evidence-based information, freely available to healthcare workers, patients and researchers.
  8. Unemo M, Ballard R, Ison C, Lewis D, Ndowa F, Peeling R. Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. Geneva: World Health Organization (WHO); 2013. p. 107–29. Available at http://www.who.int/reproductivehealth/publications/rtis/9789241505840/en/. This manual provides a basic understanding of the principles of laboratory tests in the context of screening and diagnostic approaches, as well as antimicrobial susceptibility testing, as components of STI control. It covers each disease in a separate chapter providing detailed information on specimen collection, transport, and laboratory testing.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Márcia S. Zampese
    • 1
  • Gabriela Czarnobay Garbin
    • 2
  • Bruna Guerra Rech
    • 3
  1. 1.Dermatology Service of Hospital de Clínicas de Porto AlegreFederal University of Rio Grande SulPorto AlegreBrazil
  2. 2.Dermatology of Mãe de Deus CenterPorto AlegreBrazil
  3. 3.Dermatology Service of Hospital de Clínicas de Porto AlegrePorto AlegreBrazil

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