Cutaneous manifestations of HIV infection and AIDS

Infection caused by the human immunodeficiency virus (HIV) is a disease transmitted mainly through sexual intercourse. HIV infection is characterized by damage to many systems and organs, increasing suppression of cellular immunity, which determines the striking uniqueness of its evolution, clinical manifestations and laboratory tests.

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Causes and pathogenesis of skin manifestations of HIV infection and AIDS

The disease is caused by the human immunodeficiency virus, which belongs to the group of retroviruses. The virus is able to actively penetrate T-lymphocytes - helpers with CD4 receptors.

There are two types of HIV - HIV and HIV-2, which differ in structural and antigen characteristics. HIV-1 usually acts as the causative agent of immunodeficiency. HIV has been found in many cellular elements and biological environments of patients and infected people. It has been established that the infection is transmitted only through sperm, blood, including, possibly, menstrual, cervical and vaginal discharge and breast milk. Risk groups are:

• homo- and bisexuals, prostitutes and persons leading a promiscuous sexual life with frequent changes of partners;
• drug addicts, drug addict prostitutes;
• patients suffering from hemophilia;
• children born to mothers infected with HIV.

The pathogenesis of HIV infection is based on a progressive decrease in the absolute number of T-helpers up to their complete elimination in the terminal stage.

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Symptoms of skin manifestations of HIV infection and AIDS

Skin and mucous membrane lesions allow one to suspect AIDS for the first time in many patients. At the same time, the course of dermatological diseases in HIV-infected patients has a number of features: they manifest atypically, have a severe course, and are difficult to treat. The following diseases have the greatest diagnostic value: Kaposi's sarcoma, candidiasis, simple and herpes zoster, versicolor lichen, seborrheic dermatitis, "hairy" leukoplakia of the oral mucosa, and molluscum contagiosum. The severe course of the above dermatoses, their generalization in the presence of general symptoms (fever, weakness, diarrhea, weight loss, etc.) are poor prognostic symptoms and indicate the development of clinical manifestations of AIDS.

Kaposi's sarcoma

Kaposi's sarcoma is the most characteristic dermatological manifestation of HIV infection. The disease begins at a young age with the appearance of pale pink spots and papules that slowly increase in size, acquiring a purple or brown color. Pinpoint hemorrhages appear along the periphery of the main lesion. In the initial stage of the disease, skin manifestations resemble hemangioma, pyogenic granuloma, dermatofibroma, ecchymosis. In the later stages of the disease, skin manifestations become more characteristic, infiltration and ulceration of the lesions increase. The lesions can be localized on any areas of the skin, but their location on the head, body, along the ribs is suspicious of AIDS.

In HIV-infected patients, the mucous membranes of the mouth, genitals and conjunctiva are affected.

Herpetic eruptions in HIV-infected individuals can occur on any areas of the skin and mucous membranes, most often on the lips, genitals, shins and in the perianal area, especially in homosexual men. The eruptions quickly develop into large, painful, long-lasting ulcers with irregular scalloped edges. In an atypical course, the clinical signs of herpes can resemble chickenpox or impetigo.

In HIV-infected patients, in addition to lesions of the skin and mucous membranes, herpetic proctitis occurs, which sometimes takes the form of painful edematous erythema in the perianal area.

Pityriasis versicolor in HIV-infected individuals has its own characteristics: the process is widespread, the clinical picture resembles other dermatoses (pityriasis rosea, seborrheic dermatitis); infiltration and lichenification of the skin are noted.

Candidal lesions of the mucous membranes of the mouth, pharynx, esophagus, vulva and vagina are often found in HIV-infected patients, and candidiasis of the mouth and pharynx is the first manifestation of AIDS.

The sudden occurrence of candidiasis of the mucous membranes in young people who have not taken corticosteroids, cytostatics or antibiotics for a long time is a reason to examine them for HIV infection. There are 4 clinical forms of candidiasis of the mouth and pharynx: thrush (pseudomembranous candidiasis), hyperplastic candidiasis (candidal leukoplakia), atrophic candidiasis and angular cheilitis (candidal cheilitis). HIV-infected patients often have combined lesions of the skin and mucous membranes, the disease is very severe, painful ulcers, candidal abscesses of the brain, liver and other organs are formed. The recommended traditional treatment regimens for candidiasis of the skin and mucous membranes for patients with HIV infection are ineffective.

Patients with HIV infection often have pointed condylomas, and as immunosuppression increases, they become multiple, affecting large areas of skin and mucous membranes. The therapy is ineffective.

Treatment of skin manifestations of HIV infection and AIDS

Treatment of dermatological diseases in HIV-infected patients is carried out according to generally accepted methods against the background of antiretroviral therapy. However, given the severity of the course, the dose of drugs and the duration of administration can be increased.