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Dermatological signs and symptoms of AIDS

Objective

To describe and define the dermatological signs and symptoms associated with HIV infection based on clinical, histopathological and microbiological examination. Special emphasis will be paid to HIV primary syndrome-associated mucocutaneous signs. The prevalence of mucocutaneous signs in relation to demographic and geographic differences and the stages of HIV infection will be defined. The aim will be to find out which dermatological signs are of prognostic value, and to define whether less such signs are found among patients undergoing HIV-specific therapy.
The Concerted Action (CA) is a 2 year prospective cross sectional study on the dermatological, immunological and virological parameters of approximately 1200 human immunodeficiency virus (HIV) infected individuals in different parts of Europe. The dermatological and mucocutaneous findings are considered important signs of disease progression especially during the many years of early HIV infection (prior to acquired immune deficiency syndrome (AIDS)) when few other clinical symptoms are detected. The dermatological findings may follow a typical order of appearance in relation to the deterioration of the immune system. Features of the infection of antigen presenting Langerhans cells in the skin will also be addressed. In the middle of the projects active data collection phase, 180 data collection forms representing 15% of the proposed number and returned from 11 collaborating centres have been analyzed. These patients showed 364 dermatological findings for an average of 2 per patient. 54% of the patients report homosexual or bisexual risk behaviour, 40% are heterosexual, and 65% of the latter are intravenous drug abusers. 20% of the patients enrolled by now are in the LAS phase of HIV infection, 17% have AIDS related complex (ARC) and 31% have entered the AIDS phase. The 10 most common dermatological findings in these patients were as follows: Kaposis sarcoma, seborrhoiec dermatitis, condylomata acuminata, oral hairy leukoplakia, molluscum contagiosum, pseudomembranous oral candidiasis, generalized pruritus, folliculitis, perianal herpes simplex virus infection, and psoriasis vulgaris. Only 8% of the patients had a history of herpes zoster. After finishing the data collection phase, the clinical dermatological findings will be analyzed in relation to demographic findings, disease stage, immunologic and virologic parameters. At this stage, such analysis is premature. Studies on the expression of HIV regulatory proteins in human Langerhans cells, infected either naturally or in vitro, are under progress to better understand the significance of HIV infection in the skin compartment.
The Concerted Action is a two year prospective cross-sectional study on the dermatological, immunological and virological parameters of approximately 1200 HIV infected individuals in different parts of Europe. The dermatological and mucocutaneous findings are considered important signs of disease progression especially during the many years of early HIV infection (prior to AIDS) when hardly any other clinical symptoms are detected. The dermatological findings may follow a typical order of appearance in relation to the deterioration of the immune system.
Also, features of the infection of antigen presenting Langerhans cells in the skin will also be addressed.

Coordinator

University of Helsinki
Address
Meilahdentie 2
00250 Helsinki
Finland