Skin disease among human immunodeficiency virus-infected adolescents in Zimbabwe: a strong indicator of underlying HIV infection.

Abstract

BACKGROUND:

Southern Africa is witnessing the emergence of an epidemic of long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection presenting with untreated HIV as adolescents. Dermatologic conditions, common in both HIV-infected adults and children, have not been described in this age-group. We investigated the prevalence and spectrum of skin conditions in adolescents admitted to hospitals in Zimbabwe.

METHODS:

A total of 301 consecutive adolescents admitted to 2 central Harare hospitals, underwent a dermatologic examination. Clinical history, HIV serology, and CD4 lymphocyte counts were obtained. Herpes simplex virus-2 serology was used as a surrogate marker for sexual activity.

RESULTS:

: A total of 139 (46%) patients were HIV-1 antibody positive, of whom only 2 (1.4%) were herpes simplex virus-2 antibody positive. The prevalence of any skin complaint among HIV-infected and uninfected participants was 88% and 14%, respectively (odds ratio: 37.7, 95% confidence interval: 19.4-72). The most common HIV-related conditions were pruritic papular eruptions (42%) and plane warts >5% of body area (24%). Having 3 or more skin conditions, a history of recurrent skin rashes and angular cheilitis were each associated with CD4 counts <200 cells/microL (P < 0.03, P < 0.01, and P < 0.05, respectively).

CONCLUSIONS:

Skin disease was a common and striking feature of underlying HIV-infection in hospitalized HIV-infected adolescents in Zimbabwe. In resource-poor settings with maturing epidemics, the presence of skin disease should be regarded as a strong indication for HIV testing and especially as it may reflect advanced immunosuppression. The high frequency of multiple plane warts has not previously been described, and may be a feature that distinguishes vertically-infected from horizontally-infected adolescents.

• Authors: Sara Lowe, Rashida A Ferrand, Rachael Morris-Jones, Jon Salisbury, Nicholas Mangeya, Munyaradzi Dimairo, Robert F Miller, Elizabeth L Corbett
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 29 Issue 4 Pg. 346-51 (Apr 2010) ISSN: 1532-0987 [Electronic] United States
• PMID: 19940800 (Publication Type: Journal Article)

Topics

• AIDS-Related Opportunistic Infections (complications, diagnosis, epidemiology, pathology)
• Adolescent
• Child
• Female
• HIV Infections (complications, diagnosis, epidemiology, pathology)
• Hospitalization (statistics & numerical data)
• Humans
• Male
• Prevalence
• Risk Factors
• Skin Diseases (complications, epidemiology, pathology)
• Surveys and Questionnaires
• Warts (complications, diagnosis, epidemiology, pathology)
• Zimbabwe (epidemiology)