MUCOCUTANEOUS MANIFESTATIONS IN HIV INFECTED CHILDREN CORRELATED WITH CD4+ COUNTS, PERCENTAGES AND VIRAL LOAD IN UNIVERSITY COLLEGE HOSPITAL (UCH), IBADAN

Abstract

The skin is one of the most commonly affected organs in HIV infected individuals
and a large proportion of these patients will have one mucocutaneous condition or
the other during the course of the disease. However, there is a dearth of data on
these manifestations in HIV infected children especially in Nigeria. This study was
carried out to determine the prevalence and clinical spectrum of mucocutaneous
manifestations in HIV infected children and to correlate these manifestations with
HIV associated immunodeficiency and viral load levels.
This was a descriptive comparative cross-sectional study that involved , conducted
over a three month period.HIV infected children aged between 6 weeks and 14
years and age and sex matched controls confirmed to be HIV negative.
Sociodemographic, clinical and laboratory data were obtained. A dermatologic
examination was carried out and diagnosis of the mucocutaneous lesions was
mainly clinical except where special investigations like skin biopsies were
required. Data were entered into a microcomputer and analyzed with the Epi info
version 2007.
A total of 155 HIV positive children were compared to 155 HIV negative children.
There were 92 males and 63 females (M: F=1.5:1). The mean age of the HIV
infected children was 67.23±41.04 months which was similar to the controls with a
mean of 63.51±41.19 months (p=0.430).
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The prevalence of mucocutaneous manifestations in the HIV infected group
(53.5%) was significantly higher than in the HIV negative controls (18.1%)
(p=0.000).
Twenty eight types of cutaneous lesions were found in the HIV infected group
compared to 13 types seen in the HIV negative counterparts (p=0.000).
Mucocutaneous lesions that were more prevalent in the HIV infected children
included tinea capitis (10.3%), pruritic papular eruptions (PPE) (9.0%), post
inflammatory hyperpigmentation (7.7%), digital clubbing (7.7%), viral warts
(5.2%), generalised xerosis (5.2%) and oral candidiasis (3.9%) (p<0.05). The
various infective and non-infective groups of disorders apart from malignancies
were more prevalent (p<0.05). The fungal lesions were the most prevalent
infective lesions (60%) in the subjects while the bacterial lesions (72%) were the
most prevalent in the controls.
MucoThe cutaneous lesions increased in frequencyprevalence with increasing level
of immunodeficiency, ranging from from the insignificant levels of
immunodeficiency (35.9% in the mildest form to) to the severe levels (80.6%) in
the most severe form (and this was statistically significant(p=0.000). ). Similarly,
A similar relationship was found with a a higher percentage of the casespatients
with high viral load (78.1%) hadving mucocutaneous lesions compared to those
with low viral load (47.2%) (p=0.002). A positive correlation between presence of
mucocutaneous lesions and immunodeficiency(r=0.328, p=0.001) as well as viral
load levels (r=0.251, p=0.002) was found. Oral candidiasis, tinea capitis, angular
stomatitis, fluffy hair and pruritic papular eruptions (PPE) were associated with
more severe degrees of immunodeficiency (p<0.05) while post-inflammatory
hyperpigmentation was associated with lower levels of immune deficiency
(p=0.000). Disorders associated with low viral load include papular urticaria,
seborrheic dermatitis, post inflammatory hyperpigmentation, viral warts, and
melanonychia (p<0.05). A positive correlation was found between the number of
variety of mucocutaneous lesions and levels of immunodeficiency (r=0.380, p=
0.000), viral load (r=0.272, p=0.001).
In conclusion, mucocutaneous disorders wereare highly prevalent significantly
commoner in HIV infected children and . These disorders increased in frequency
and severity are more prevalent and increase in number and severity with
worsening immune status and highincreasing viral load. There should be a high
index of suspicion for HIV infection in children presenting with certain
mucocutaneous lesions like pruritic papular eruptions, oral candidiasis and severe
forms of tinea capitis. These lesions could also be useful in monitoring the
progress of the disease.

MUCOCUTANEOUS MANIFESTATIONS IN HIV INFECTED CHILDREN CORRELATED WITH CD4+ COUNTS, PERCENTAGES AND VIRAL LOAD IN UNIVERSITY COLLEGE HOSPITAL (UCH), IBADAN