Skin manifestation of HIV infection and AIDS

Infection caused by the human immunodeficiency virus (HIV) is a disease transmitted mainly through sexual intercourse. In HIV infection, many systems and organs are affected, the growing inhibition of cellular immunity, which determines the vivid identity of its evolution, clinical manifestations and laboratory tests.

[1], [2], [3], [4], [5], [6]

Causes and pathogenesis of cutaneous manifestations of HIV infection and AIDS

The disease is caused by the human immune deficiency virus, which belongs to the group of retroviruses. The virus is able to actively penetrate into T-lymphocytes - helper cells having CD4-receptors.

There are two types of HIV -HIV and HIV-2, differing in their structural and antigenic characteristics. As the causative agent of immunodeficiency HIV-1 usually acts. HIV is found in many cellular elements and biological environments of patients and infected. It is established that the infection is transmitted only through sperm, blood, including, possibly, menstrual, cervical and vaginal discharge and breast milk. Groups of risk are:

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

At the heart of the pathogenesis of HIV infection is the increasing decrease in the absolute number of T-helpers until their complete elimination in the terminal stage.

[7], [8]

Symptoms of cutaneous manifestations of HIV infection and AIDS

The defeat of the skin and mucous membranes allows for the first time to suspect AIDS in many patients. At the same time, the course of dermatological diseases in HIV-infected patients has a number of peculiarities: they are atypical, have severe course, and are difficult to treat. The following diseases are of the greatest diagnostic importance: Kaposi's sarcoma, candidiasis, simple and herpes zoster, lichen colored, seborrheic dermatitis, "hairy" leukoplakia of the oral mucosa, molluscum contagiosum. The severe course of these 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, which slowly increase in size, acquiring a purple or brown color. On the periphery of the main focus there are pinpoint hemorrhages. In the initial stage of the disease skin manifestations resemble hemangioma, pyogenic granuloma, dermatofibroma, ecchymosis. In later stages of the disease, skin manifestations become more characteristic, infiltration and ulceration of lesions increase. Elements of lesions can be localized on any parts of the skin, but their location on the head, trunk, along the ribs is suspicious of AIDS.

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

Herpetic eruptions in HIV-infected people can occur on any areas of the skin and mucous membranes, most often on the lips, genitals, tibia and perianal region, especially in male homosexuals. Eruptions quickly turn into large painful, long-lasting non-healing ulcers with irregular scalloped margins. In atypical course clinical signs of herpes can resemble chicken pox or impetigo.

In HIV-infected patients, in addition to skin and mucous membrane damage, there is a herpetic proctitis, which sometimes takes the form of a painful edematous erythema in the perianal region.

Multicolored lichen in HIV-infected individuals has its own characteristics: the process is widespread, the clinical picture resembles other dermatoses (pink lichen, seborrheic dermatitis); infiltration and lichenification of the skin.

Candidiasis of the mucous membrane of the mouth, pharynx, esophagus, vulva and vagina is often found in HIV-infected patients, and candidiasis of the mouth and pharynx is the first manifestation of AIDS.

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

In patients with HIV infection, genital warts often occur and, as immunosuppression increases, they become multiple, affecting large areas of the skin and mucous membranes. Conducted 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 admission can be increased.