Eye, skin disorders may mean HIV infection.

Eye, Skin Disorders May Mean HIV Infection

Certain eye lesions or skin conditions may be early physical signs that people are infected with the human immunodeficiency virus (HIV), according to reports released this week.

Although these indicators have been associated with fully developed AIDS for several years, the new reports are the first large-scale studies associating them with early stages of HIV infection, which eventually can lead to AIDS. The findings will help increase physician awareness, leading to earlier diagnosis and treatment, researchers say.

"This is just the tip of the iceberg. We've just begun to understand how HIV affects the nervous system, for example,' says Alfred Saah, an associate professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health in Baltimore.

In a study presented at the American Academy of Ophthalmology's meeting in Dallas, five patients with retinal disease, but who otherwise appeared healthy, were diagnosed with HIV infection, says William R. Freeman, an assistant professor of ophthalmology at the University of California at San Diego, who led the study.

Of those five, two had cytomegalovirus (CMV) retinitis, or inflammation of the retina, two had a bacterial infection of the retina and one had "cotton wool spots,' which are small white areas of retinal thickening.

Freeman also studied 13 patients with ARC, or AIDS-related complex, which can develop into AIDS and which typically is characterized by fatigue, weight loss and swollen glands. He found that nine had CMV retinitis and four had cotton wool spots. Previously, researchers had thought that eye lesions, which are associated with about 75 percent of AIDS cases, developed only later in the disease. In fact, CMV retinitis is considered one of the various opportunistic infections defining the onset of fully developed AIDS.

This characterization may lead ophthalmologists to misdiagnose CMV retinitis in patients who seem otherwise healthy. They then may prescribe medication, such as steroids, and find that the infection only worsens. Meanwhile, the diagnosis of possible HIV infection may have been missed, Freeman told SCIENCE NEWS.

Freeman mentions another possible scenario: "If someone with weight loss or fatigue comes to a physician's office, the physician should check the eye for any lesions,' Freeman says. Before considering the possibility of HIV infection, however, the physician should rule out diabetes, hypertension and other ailments that can cause eye lesions.

A similar process of elimination should be used by physicians dealing with certain skin disorders that may indicate HIV infection, says Sirkka-Liisa Valle, a dermatology researcher at Aurora Hospital in Helsinki, Finland. In a study involving 237 homosexual or bisexual men, to appear in the December JOURNAL OF THE AMERICAN ACAMDEMY OF DERMATOLOGY, Valle showed that three skin disorders were found in the 11 subjects with asymptomatic HIV infection and in the three subjects with ARC: an overgrowth of Candida yeast in the mouth, scaling of the face, scalp and skin, and drying of the skin. The severity depended upon the HIV infection's stage.

Says Marcus Conant, chairman of the California State Department of Health Task Force on AIDS and clinical professor of dermatology at the University of California Medical School at San Francisco: "We need to let dermatologists know that AIDS is spreading outside the high-risk groups and these disorders should make physicians think twice.'