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HIV-Associated Mucocutaneous Disorders: A Complex Spectrum of Diseases

Strategic Insights

— 3 min read

The increasing prevalence of HIV infection among the general population poses a significant challenge for primary care physicians. Dermatologic manifestations of HIV infection can vary greatly, ranging from benign skin conditions to life-threatening diseases. According to the American Academy of Dermatology Symposium on AIDS, HIV-infected individuals are at a higher risk of developing various skin conditions, including psoriasis, cutaneous lymphoma, and drug reactions.

Key Takeaways:

  • 30% of HIV-infected patients experience temporary remission with systemic interferon alfa-2b (Reference 8).
  • Psoriasis affects 1-2% of the general population and 5% of HIV-infected persons (Reference 3).
  • Arthritis occurs in 30% of HIV-infected persons with psoriasis, in contrast to 5% of persons with psoriasis but without HIV (Reference 8).
  • Methotrexate should not be used in immunocompromised persons, and some investigators advocate testing for HIV infection before using the drug (Reference 1).
  • Treatment with zidovudine has at times relieved psoriasis (Reference 1).
  • Etretinate has been used in severely affected patients with Reiter's syndrome (Reference 12).
  • Drug reactions are extremely common in HIV-infected patients, with 48% of patients experiencing a skin rash while taking trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra) (Reference 1).
  • An interesting phenomenon seen with the use of zidovudine is discoloration of the nails, lateral tongue, and lateral abdomen, which is dose-dependent and reversible (Reference 13).
  • Other drugs commonly used for HIV infection that have caused cutaneous reactions include dapsone, ketoconazole, pyrimethamine (Daraprim), amphotericin B (Fungizone), and pentamidine isethionate (NebuPent, Pentam 300) (Reference 1).
  • Dry skin, or xerosis, is common and bothersome in patients with HIV infection, and may lead to exfoliative dermatitis, desquamation of the skin, and even ichthyosis (Reference 9).
  • Ichthyosis can also be a sign of underlying lymphoma (Reference 9).
  • HIV infection can cause profound thrombocytopenia, and petechiae may develop (Reference 14).
  • Pruritus is a common symptom of HIV infection, and can be an initial symptom (Reference 14).

Statistics:

  • 30% of HIV-infected patients experience temporary remission with systemic interferon alfa-2b.
  • 1-2% of the general population is affected by psoriasis, while 5% of HIV-infected persons are affected.
  • 30% of HIV-infected persons with psoriasis experience arthritis, compared to 5% of persons with psoriasis but without HIV.
  • 48% of HIV-infected patients experience a skin rash while taking trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra).
  • 30% of HIV-infected patients experience temporary remission with systemic interferon alfa-2b (Reference 8).
  • 1-2% of the general population is affected by psoriasis, while 5% of HIV-infected persons are affected (Reference 3).

Sources:

  • 1. Berger TG. Dermatologic manifestations of HIV infection. In: Cohen PT, Sande MA, Volberding PA, eds. The AIDS knowledge base: a textbook on HIV disease from the University of California, San Francisco, and the San Francisco General Hospital. Waltham, MA: Medical Publishing Group, 1990:5.3.1.
  • 2. Jewell ME, Sweet DE. Asymptomatic HIV infection: a primary care disease. Post grad Med 1992;92(5):155-66
  • 3. Kaplan MH, Sadick N, McNutt NS, et al. Dermatologic findings and manifestations of acquired immunodeficiency syndrome (AIDS). J Am Acad Dermatol 1987;16(3 Pt 1):485-506
  • 4. Powderly WG. Mucosal candidiasis caused by non-albicans species of Candida in HIV-positive patients. (Letter) AIDS 1992;6(6):604-5
  • 5. Katz MH, Greenspan D, Westenhouse J, et al. Progression to AIDS in HIV-infected homosexual and bisexual men with hairy leukoplakia and oral candidiasis. AIDS 1992;6(1):95-100
  • 6. Masouredis CM, Katz MH, Greenspan D, et al. Prevalence of HIV-associated periodontitis and gingivitis in HIV-infected patients attending an AIDS clinic. J Acquir Immune Defic Syndr 1992;5(5):479-83
  • 7. Berger TG, Obuch ML, Goldschmidt RH. Dermatologic manifestations of HIV infection. Am Fam Physician 1990;41(6):1729-42
  • 8. Friedman-Kien AE, Harte JS. American Academy of Dermatology Symposium on AIDS. Atlanta, Georgia, Dec 1, 1990. J Am Acad Dermatol 1991;25(6 Pt 1):1086-91
  • 9. Valle SL. Dermatologic findings related to human immunodeficiency virus infection in high-risk individuals. J Am Acad Dermatol 1987;17(6):951-61
  • 10. Penneys NS, Hicks B. Unusual cutaneous lesions associated with acquired immunodeficiency syndrome. J Am Acad Dermatol 1985;13(5 Pt 1):845-52
  • 11. de Boer WA, Danner SA. HIV infection and squamous cell carcinoma of sun-exposed skin. (Letter) AIDS 1990;4(1):91
  • 12. Berger T. Dermatologic manifestations of HIV infection. AIDS Clin Care 1990;2(7):57-64
  • 13. Greenberg RG, Berger TG. Nail and mucocutaneous hyperpigmentation with azidothymidine therapy. J Am Acad Dermatol 1990;22(2 Pt 2):327-30
  • 14. Shapiro RS, Samorodin C, Hood AF. Pruritus as a presenting sign of acquired immunodeficiency syndrome. J Am Acad Dermatol 1987;16(5 Pt 2):1115-7

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