HIV/AIDS is currently the most pressing medical and social problem. Every year, the number of people living with HIV/AIDS continues to grow in all countries of the world. According to the WHO, 15 thousand people are infected with the human immunodeficiency virus every day, or 5 people every 1 minute.
Every year the number of people with terminal stages of HIV infection (AIDS itself), which causes mortality, is growing. Therefore, in order to reduce the number of AIDS patients and prevent the spread of the infection among the population, timely detection and treatment of HIV-infected persons, especially in the early stages of the disease, is important, which is facilitated by their diagnosis by the manifestations of HIV/AIDS on the skin.
According to the WHO classification (2006), there are four stages in the course of HIV/AIDS with the following skin manifestations:
Clinical stage I:
Asymptomatic course.
Persistent generalized lymphadenopathy.
Clinical stage II:
Moderate unmotivated weight loss (up to 10%).
Herpes zoster.
Papular itchy dermatitis.
Seborrheic dermatitis.
Fungal lesions of the nails.
Clinical stage III:
Weight loss (>10%), chronic diarrhea, fever, anemia, severe bacterial infections (pneumonia, meningitis, gingivitis, etc.).
Oral candidiasis.
Hairy leukoplakia of the tongue.
Clinical stage IV:
Wasting syndrome (HIV cachexia).
Kaposi’s sarcoma.
Chronic viral infection.
After infection with the immunodeficiency virus, the disease is usually asymptomatic for a long time. Manifestations of the first clinical stage may include enlarged lymph nodes (generalized lymphadenopathy) without affecting the general condition of infected individuals.
With the development of the second clinical stage of HIV infection, characteristic changes occur on the skin and mucous membranes, which are manifestations of infectious and non-infectious dermatoses. For example, the earliest and most common sign of HIV infection is herpes zoster, a viral skin disease that in HIV-infected individuals is manifested by a significant number of blisters that occur against the background of redness and swelling of the skin, are accompanied by sharp pain, tend to widespread skin damage, often become suppurative, are difficult to treat, and can recur, leaving scarring of the skin.
One of the earliest manifestations of HIV infection can be papular pruritic dermatitis in the form of widespread (on the trunk, extremities) small nodular elements of pinkish-red color with a bloody crust in the center, accompanied by itching.
The first symptom of HIV infection can be seborrheic dermatitis of the face in the form of redness and flaking on the forehead, cheeks and nose in the form of a “butterfly”. In the future, dermatosis can spread to other areas (trunk, buttocks, thighs) with complications of pustular rash.
An early manifestation of HIV infection is fungal nail disease – onychomycosis. The nail plates become dull, thickened, and fragile. Due to immunodeficiency, all nail plates of both feet and hands are rapidly affected.
During the third clinical stage, every second HIV-infected person is diagnosed with oral candidiasis, which develops in the form of whitish layers on the mucous membranes of the tongue and cheeks and is characterized by resistance to fungicidal therapy.
One of the most characteristic manifestations of HIV infection is hairy leukoplakia of the tongue, which occurs on the lateral surfaces of the tongue in the form of single gray-white plaques up to 3 cm in diameter with thin keratotic processes (in the form of hairs) on their surface.
At the final (fourth) stage of HIV infection, which is actually called AIDS – acquired immunodeficiency syndrome, Kaposi’s sarcoma develops on the skin and mucous membranes, along with chronic viral infection (recurrent herpes of the face, genitals, etc.), in the form of plaques and nodules of deep dark bluish, brown or black color with a smooth shiny surface. The features of Kaposi’s sarcoma in AIDS patients are the location of the rash on the upper torso, upper extremities, face, and oral mucosa, as well as a tendency to rapid disintegration with the formation of ulcers and early metastasis to internal organs.
Thus, dermatologic manifestations of HIV/AIDS can include a variety of infectious and non-infectious dermatoses, which, in the context of immunodeficiency, acquire a severe clinical course. For the purpose of early detection and timely treatment of HIV-infected persons, knowledge of dermatological manifestations of HIV/AIDS is necessary not only for infectious disease specialists and dermatovenereologists, but also for general practitioners – family medicine and other medical specialists.