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A hospital based cross sectional study of mucocutaneous manifestations in the HIV infected.

Background

"Infectious diseases will last as long as humanity itself"

Diseases are curse to mankind and HIV/AIDS has worsened it. According to recent Data, 33.2 million [30.6m-36.1m] are living with HIV worldwide, of which 2.5 million are newly infected cases in 2007 and 2.1 million died of AIDS in 2007 (UNAIDS update, 2007). Data from NACO says 2.5 million are HIV infected in India & Karnataka is one of the high prevalence states (NACO document, 2006). HIV infection produces a panorama of mucocutaneous manifestations, which may be the presenting feature of the disease. This ranges from macular, roseola like rash in the acute seroconversion syndrome to extensive end-stage Kaposi sarcoma. Dermatological features of HIV disease can be seen throughout the course of the HIV infection. So early diagnosis & early institution of therapy is required. With the advent of HAART, the course of HIV/AIDS has been significantly changed and thus associated dermatological lesions also (Maurer and Lori, 2004).Certain study showed dermatological lesions are indicators of immune status of the individuals. So here is an attempt to find the prevalence of dermatological lesions in HIV/AIDS infected their association with CD4+ cell count and to compare the prevalence of dermatological lesions between patients on HAART and patients not on HAART since 50% of the study populations are on HAART.

In this research work, 350 cases of HIV with skin lesions are studied of which 50% are on HAART. [Lamivudine, Stavudine & Nevirapine provided by NACO under brand name Emtri 30/40] & the remaining 50% were not on HAART.

Methodology and Materials

Study design: Cross-sectional study

Type of the study: Hospital based cross sectional study

Sampling technique: Simple random sampling.

Total number of new cases with mucocutaneous manifestations and those patients with mucocutaneous manifestation already on treatment for the year 2005-2006 was taken and sampling was done using software SPSS version 13.

Sample size: 350 members out of which 175 are on HAART (cat-2), and remaining 175 members are not on HAART (cat-1). The sample size was calculated by taking prevalence of skin manifestations among HIV positive patients as 39.3%. Sample size was calculated at 5% significant level and 10% error using software SPSS version 13.

Method of the study: The study was conducted at the Skin and STD Department of Krishna Rajendra (K.R) Hospital allied to the Mysore Medical College and Research Institute, Karnataka from August 2007 to October 2008. The study group includes 175 patients who presented with a symptom of one of the mucocutaneous lesions. They did not know if they were HIV infected. After they were tested they were found to be positive and were included in the study.

Another 175 HIV positive patients, who are on HAART presenting with some mucocutaneous manifestations were procured from ANTI RETROVIRAL CENTRE of our hospital and were involved in the study after confirming the below mentioned criteria.

Inclusion criteria

1. HIV positive patients (positivity confirmed by ELISA method at VCTC centre of our hospital) giving consent to the study.

2. Age between 16 years to 60 years old.

Procedure

Before involving the patient in the study, depending on their educational status, written informed consent were obtained from the patient/legal guardian in English. Clearance from the institutional ethics committee was also obtained, Data was collected based on the proforma, which includes demographic profile and clinical findings. Findings were noted by the student under the guidance of the guiding professor. Finally, counseling was done regarding hygiene and diet.

Laboratory Investigations

1. HIV status was confirmed by ELISA method at VCTC centre of our hospital

2. Base line investigations were done to all patients such as Hb%, peripheral blood smear examination (PBS).

3. CD4+ count was estimated by FACS (fluorescence activated Cell sorter) count system at the department of Microbiology.

4. Potassium hydroxide (KOH) preparation was used to confirm Dermatophytosis.

5. VDRL tests were done to confirm syphilis infection.

Results

When socio-demographic profile was considered male and female patients are almost equal (Table 1). With low socioeconomic history, most of them acquired the infection from heterosexual contact. Among which about 90% of the female patients acquired from their husband.

When category I patients were considered; i.e. those who presented without the knowledge of their HIV status, Oral Candidiasis was the leading presenting complaint seen in 28% of the study population (Table 6). It is followed by Molluscum Contagiosum (24%) and then by Condyloma Acuminatum (20%) which was seen only in male patients and Multidermatomal Herpes Zoster (16%) (Table 2). So any patient with these symptoms can be suspected as a case of HIV if other conditions are ruled out. When all the infectious mucocutaneous manifestations were considered together, viral infections comprised of 56 %(196); among which 71.42 %(140) were in cat-1(non-HAART) And 28.58 %(56) in cat-2(underHAART).This shows a significant reduction in viral opportunistic infection [chisquare=5.143:p<.023] among patients after the initiation of HAART[median duration of HAART in our study group was 6 months and combination used in our set up was Lamivudine, Stavudine and Nevirapine under the brand name Emtri 40/30]. One case of Pityriasis Rosea, resistant to routine mode of treatment was seen, but no other literature mentions its association. So, further studies are required in this line.

When the prevalence of dermatological lesions of patients who are on HAART [Emtri[right arrow]lamivudine, Stavudine and Nevirapine, with median duration of 6 months], was compared with that of category I (non-HAART), there was significant reduction in the prevalence of dermatological viral infections in Cat II [under HAART--chi square = 5.134; p< 0.023] (Table 10). But the prevalence of bacterial and fungal infections showed no change [p = 0.763 (NS) and p = 0.827 (NS) respectively] (Table 11 and 12). When non-infectious lesions were considered, there was a significant [chi square = 4.50; p <0.034 (S)] increase in the prevalence among Cat II (under HAART) which was accounted by absolute increase in drug eruption and pruritic papular eruption (Table 13).

Discussion

Out of 350 cases studied, 52 % (182) were males and 48 % (168) were females. The subjects between 26-35years of age group were significantly high [chi-square=18.60; p<0.005]. Among which, we had 24 % (84) in 26-30 year age group and 30 % (105) in 31-35 year age group. This correlated with Bravo et al. (2006) who found out that the most affected age group was 30 to 39yrs-51%. The frequency of males and females in this age group was almost similar. Only 4 % (14) of individuals were in 16-20 years and none in between 51-60years. Thus study shows the high prevalence of HIV/AIDS in middle aged population resulting in considerable reduction in the manpower and increase in the economic burden of the nation (NACO Document, 2006).

When occupation was considered, 48% (168) were involved in unskilled occupation [chi-square=14.8; p<.002], among which female patients constituted for 75% (126) of the total. It is followed by skilled worker, i.e. 22% (77), in which male patients showed an upper hand which is followed by farmers 16 % (56) and semiskilled workers 14 % (49). This correlates with Singh et al. (2009) whose study also consisted of 46% unskilled workers, semi- skilled workers formed 23% and farmers formed 5% of the group. Mode of acquiring the disease among the study group was absolutely heterosexual, no other modes were reported. This is similar to Singh et al. (2009) who reported 94.16% heterosexual transmission. In our study, 28% (98) denied any mode of transmission, while the other 72% (252) admitted the heterosexual mode of transmission. Of them 36 % (126), who were all females acquired from their spouse. In remaining 36 % (126), who acquired from external source, 88.8 % (112) were males and 11.11 % (14) were females. Most of the males acquired from Commercial sex workers (CSW) and out of 2 females 1 was CSW and other admitted her high risk behavior.

From this we can conclude that low socioeconomic status may be one of the associated factors for rampant HIV/AIDS in our country.

Condyloma acuminatum 14 % (49) was the common diagnosis among the viral OIs, of which 71.4%(35) cases were cat-1 and 28.5%(14) cases in cat-2 which shows decrease in the prevalence among HAART initiated patients .Mean CD4+ cell count among cat-1 was 197cell/[mm.sup.3] and in cat-2 was 319cell/[mm.sup.3]. When compared to Munoz Perez, Rodriguez-Pichardo, Camacho, & Colmenero,(1998) this is bit high as they report that HIV infection itself predisposes to an increased risk of HPV infection that is not directly related to the degree of immunosuppression. Studies by Shobhana, Guha, and Neogi DK (2004) show still low i.e. 0.5%. Our study is comparable to Hengge et al. (2000) as they also found a significant decrease in the prevalence of Condyloma acuminatum in their study recruited after the initiation of HAART.

Herpes zoster (HZ) was the next most common [12 % (42)] diagnosis. This is comparable to Kumarasamy et al. (2000) and Mbuagbaw et al. (2006) who reported a prevalence of 11.2% and 9.7% respectively. In our study, among the 12% (42) of cases, 67 % (28) cases were in cat-1 and 33 % (14) cases were in cat-1 and 33 % (14) cases were in cat-2. Mean CD4+ count for cat-1 was 273.2 cell/[mm.sup.3], but in cat-2 mean CD4+ Count was significantly low i.e. 56 cell/[mm.sup.3]. This shows that HZ can occur at all degree of immunosuppression. Hengge, Ulrich R, Franz, Barbara, Goos(2000) reports the HZ incidence is directly related to the viral load. This may be the reason why our patients (cat-2) had significant high prevalence as their CD4+ Count was too less, which is the indirect evidence of high viral load and thus they are on HAART.

Molluscum contagiosum [12 % (42)] was seen only in cat-1 patients with mean CD4+ of 155.1cell/[mm.sup.3] which (CD4+ Count) is higher than that reported by Sen et al. (2009) who reported a mean CD4 count of 98cells/cu.mm. This finding is significant as no cases were seen in patients under HAART (cat-2).

Herpes simplex virus (HSV) genitalis [10 % (35)], HSV labialis [2% (7)] were frequent viral OIs. Among HSV Genitalis, 80% (28) of the cases were in cat-1 and only 20% (7) in cat2.Our study is comparable to Shobhana, Guha, and Neogi (2004) which shows (8%) with mean CD4+ Count of 187cell/[mm.sup.3] against 211.5 of our study, but Nair SP, Moorty KP, Suprakasan S (2003) reports very low prevalence (2.74%). Our study was also comparable to Munoz-Perez, et al. (1998) as they also reported reduced prevalence in "under HAART" category. HSV labialis was seen only in Cat-2 and no other study reports association, this may be coincidental.

Verruca vulgaris 6% (21), of which 33% (7) were in cat-1 and almost double cases in cat-2. This is comparable to Hengge et al. (2000) as they also reported the increase in prevalence in their "under HAART" category.

Bacterial skin infections were seen in 22 % (77) of the subjects, which was suspected to be caused by Staphylococcus aureus. This is comparable to Bhandary et al. (1997) who report a prevalence of 25%. When individual lesions such as Furuncle (8%), Carbuncle (2%), Folliculitis (8%), Abscess (2%) are considered it is comparable to Munoz Perez et al. (2008) reported 1.6% prevalence of folliculitis, which is lower compared to our study but a CD4 count of 127.3cells/cu.mm which is comparable to CD4 count of 130cells/cu.mm in our study. When cat-1[45.54 % (35)] and cat-2[54.45 %(42)]was considered, there is slight increase in cat-2, even when they are in HAART. This may be attributed to the poor socio economic status of our study population. 7 (4%) cases of syphilis were reported in cat-1 and none in cat-2.

Fungal infection comprised of 42 % (147), of which Dermatophytes accounted for 22 % (77), oral candidiasis-14 % (49), Onychomycosis-4 % (56), pityriasis versicolor-2% (7). When Dermatophytes 22 % (77) were considered, it was slightly higher than other studies such as Samet et al. (1999) who reported a prevalence of 34%. This is due to lower socioeconomic status of our study population. When cat-1[18.18 % (14)] and cat-2 [81.81 % (63)] were considered separately, there was significant high prevalence [p<.05] among cat-2 group. Individual lesion of cat-1 such as tinea pedis [4 % (7)] and tinea cruris [4 % (7)] with mean CD4+ count of 79cell/[mm.sup.3] were comparable to Munoz Perez et al. (1998),But prevalence of lesions in cat-2 were significantly high may be due longer duration of mean HIV positive life when compared to cat-1, where they are recently infected. 4% (14) of Onychomycosis and 2% (7) of pityriasis versicolor were seen. Prevalence of onychomycosis was equal in cat-1 and cat-2, and no cases of pityriasis versicolor in cat-2. Prevalence of onychomycosis was comparable to MunozPerez et al. (1998) (4%) but CD4+ count was very low, 67cell/[mm.sup.3] against their 161cell/[mm.sup.3]. Mean CD4+ Count of pityriasis versicolor was 46cell/[mm.sup.3]. Oral candidiasis accounted for 14 % (49), seen only in cat-1, with mean CD4+ Count of 150.8.This prevalence was lower than that reported by Sengupta et al. (2000) -36%. Among 49 cases, 42 cases were pseudomembranous type and 7 cases of erythematous type. Mean CD4+ Count was 150.8cell/[mm.sup.3].

Among infestations, 7 cases of scabies were diagnosed in cat-1 and none in Cat- 2 that was comparable to Kumarasamy et al. (2000) (0.5%).

Non-infectious lesions were present in 64 % (224) of the study group in which the incidence in category 2 [68.75 % (154)] was significantly higher, when compared to category 1 [31.25 %(70)]. When each lesion was considered separately seborrhoeic dermatitis 14%

(42) was the most common diagnosis, of which 29 % (14) were in category 1 and 71 % (35) cases were in category 2 and mean CD4+ count was 85.05cells/cu.mm. The prevalence was bit high when compared to other studies such as Sen et al. (2009) where the prevalence was 8.5%. This is probably because their study was conducted in a more mild and temperate climate. Rajagopalan, Jacob, and George (1996) also showed increased prevalence compared to our study. Hengge et al. (2000) reports decrease in prevalence from 25.3% to 17.6% in patients who are HAART. But a paradoxical increase was seen in cat-2(under HAART) study group in our study.

Xerosis was the next common [10 % (35)] diagnosis of which 40 % (14) cases were in Cat-1 (non HAART) and 60% (21) in cat-2. The mean CD4+ count was very low (35.75cells/[mm.sup.3]).The prevalence in our study is low compared to that reported by Sud et al. (2009) -22.7%. There was a bit high prevalence in cat- 2 (HAART) when compared to cat-1 but Maurer and Lori (2004) reports a decreased prevalence in HAART initiated patients. And most of the patients were cachexic.

Eosinophilic folliculitis was seen in 6 % (21) of study population of which 66.7% (14)were in cat -1 (non HAART) and 33.3% (7) were in cat-2(HAART). In our study mean CD4+ count was 121.5cell/[mm.sup.3], out of the 21 cases diagnosed, 14 cases fulfilled the criteria [clinical, Histopathology and laboratory], but other seven cases were diagnosed only on clinical grounds. This was comparable to CD4 count of 115.54cells/cu.mm reported by Priya et al. (2005)

Pruritic papular eruptions (PPE) were seen in 8 % (28) of our patients, and all of them were from cat-2, with mean CD4+ Count of 119.2cell/[mm.sup.3]. This is comparable to Lakshmi et al. (2008) who report a prevalence of between 11 and 46% with a mean CD4 count of 153 cells/cu.mm. Also the CD4+ Count of 119.2cell/[mm.sup.3] was comparable to Boonchai et al. (1999) where they reports PPE as a marker of advanced HIV (low CD4+ count). To support this evidence, PPE was seen only in cat-2 patients as these patients were on HAART owing to their advanced HIV infection.

Drug eruption was seen in 12% (42) of our patients. Nair, Moorty, and Suprakasan (2003) (1.65%) reports very low prevalence probable because their patients were in initial stages of the disease against our population, where it is seen only in cat-2 ,who were in advanced stage of the infection .Of 12% (42), 8% (28) were Nevirapine rash[ erythema multiforme and acneform eruptions] and 4%(14) were Lichenoid eruptions. Mean CD4+ Count was 92cell/[mm.sup.3]. This is illustrated by Coopman et al. (1993) who have shown that it is extremely common in HIV infected patients and prevalence increases as the immune function deteriorates.

One case of pityriasis rosea was diagnosed in cat-1, but no literature mentions it as an opportunistic infection (OI). Some workers such as Robert A Allen, Robert A Schwartz(2009) associates Human Herpes Virus -7(HHV-7) as causative agent .Since herpes group of virus are common opportunistic agents in HIV infection, this may be a true association and further study is required in this regard.

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Conclusion

Oral Candidiasis was the leading presenting complaint followed by Molluscum Contagiosum, Condyloma Accuminata (seen only in male patients) and Multidermatomal Herpes Zoster. So any patient with these symptoms can be suspected as a case of HIV if other conditions are ruled out.

In correlation with CD4 cell count mucocutaneous manifestations increased with decreased CD4 cell count [Regression Coefficient (-0.31) with 0.64 standard error of estimate and p-value <0.05].

When dermatological lesions of patient who are on HAART was compared with that of non-HAART, there was significant reduction in the prevalence of dermatological viral infection in CAT 2[under HAART-chi square=5.134; p<0.023].But prevalence of bacterial and fungal infections showed no change [p=0.763(NS) and P=0.827(NS) respectively].This may be due to poor socioeconomic status and poor hygiene. Since the study mainly involved patients of lower socioeconomic status, we suggest further studies be conducted by involving patients of higher socioeconomic status matched for all other criteria. However HAART improves the quality of life in the HIV infected (Orlovic & Smego, 2009).

Abbreviations

Cat-1: (category-1) Patients directly presenting to skin and Std. dept. without knowing their HIV status, i.e., not on HAART

Cat-2: (category-2) Patients on HAART.

HAART- Highly active antiretroviral therapy

NACO-National AIDS Control Organisation

CD4+ -Cluster of differentiation 4

KOH-Potassium Hydroxide mount

STD-Sexually transmitted disease

HIV- Human Immunodeficiency Virus

AIDS-Acquired Immunodeficiency Syndrome

VDRL- Venereal Disease Research Laboratory

ELISA- Enzyme Linked Immunosorbent Assay

VCTC-Voluntary Counselling and Testing Centre

OI- Opportunistic Infection

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References

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Attili VSS, Singh VP, Sundar S, Gulati AK, Varma DK, Rai M. Relationship between skin diseases and CD4 cell count in a hospital based cohort of HIV infected adults in North India. Journal, Indian Academy of Clinical Medicine (JIACM). 2008;9(1):20-5.

Bhandary PG, Kamath NK, Pai GS, Rao G. Cutaneous manifestations of HIV infection. Indian J Dermatol Venereol Leprol. 1997;63:35-7.

Boonchai W, Laohasrisakul R, Manonukul J, Kulthanan K. Pruritic papular eruption in HIV seropositive patients: a cutaneous marker for immunosuppression. International Journal of Dermatology. 1997; 38(5):348-350.

Bravo IM, Correnti M, Escalona L, Perrone M, Brito A, Tovar V, et al. Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population. Med Oral Patol Oral Cir Bucal. 2006;11:E1-5.

Coopman SA, Johnson RA, Platt R, Stern R. Cutaneous disease and drug reactions in HIV Infection. N Engl J Med 1993;328(23):1670-4.

Hengge UR, Franz B, Goos M. Decline of infectious skin manifestations in the era of highly active antiretroviral therapy, AIDS. 2000;14(8):1069.

HIV Estimates in India for the year 2006. NACO document; http://www.naco. nic.in/indianscene/ esthiv. htm.

Kumarasamy N, Solomon S, Madhivanan P, Ravikumar B, Thyagrajan SP, Yesudian P. Dermatological manifestations among human immunodeficiency virus patients in South India. Int J Dermatol. 2000;39:192-5.

Maurer T, Rodrigues LKE, Ameli N, Phanuphak N, Gange SJ, DeHovitz J, French AL, Glesby M, Jordan C, Khalsa A, Hessol NA. The Effect of Highly Active Antiretroviral Therapy on Dermatologic Disease in a Longitudinal Study of HIV Type 1-Infected Women. Clinical Infectious Diseases. 2004;38(4):579-584.

Mbuagbaw J, Eyong I, Alemnji G, Mpoudi N, Same-Ekobo A. Patterns of skin manifestations and their relationships with CD4 counts among HIV/AIDS patients in Cameroon. Int J Dermatol. 2006;45:280-4.

Munoz-Perez MA, Rodriguez-Pichardo A, Camacho F, Colmenero MA. Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse. British Journal of Dermatology. 1998;139(1):33-39.

Nair SP, Moorty KP, Suprakasan S. Clinico-epidemiological study of HIV patients in Trivandrum. Indian J Dermatol Venerol Leprol. 2003;69:100-3.

Samet JH, Muz P, Cabral P, Jhamb K, Suwanchinda A, Freedberg KA. Dermatologic manifestations in HIV-infected patients: a primary care perspective. Mayo Clin Proc. 1999;74(7):658-60.

Sen S, Halder S, Mandal S, Pal PP, Halder A, Bhaumik P. Clinico-epidemiological profile of cutaneous manifestations among human immunodeficiency virus positive patients in the sub-Himalayan region. Indian J Dermatol Venereol Leprol. 2009;75:403-5.

Sengupta D, Rewari BB, Mishra SN, Joshi PL, Prasada Rao JVR. Spectrum of opportunistic infections in AIDS: Trends from India. JIACM. 2000;4:99-103.

Shobhana A, Guha SK, Neogi DK. Mucocutaneous manifestations of HIV infection. Indian J Dermatol Venereol Leprol. 2004;70:82-86.

Singh H, Singh P, Tiwari P, Dey V, Dulhani N, Singh A. Dermatological manifestations in HIV-infected patients at a tertiary care hospital in a tribal (Bastar) region of Chhattisgarh, India. Indian J Dermatol. 2009;54(4):338-41.

Sud N, Shanker V, Sharma A, Sharma NL, Gupta M. Mucocutaneous manifestations in 150 HIV infected Indian patients and their relationship with CD4 lymphocyte count. International Journal of STD and AIDS. 2009;20:771-774.

Rajagopalan B, Jacob M, George S. Skin lesions in HIV positive and negative patients in South India. Int J Dermatol. 1996;35(7):489-92.

Lakshmi SJ, Raghurama GR, Ramalakshmi, Satyashree, Rao KA, Prasad PG, Kumar YHK. Pruritic papular eruptions of HIV: A clinicopathologic and therapeutic study. Indian J Dermatol VenereolLeprol. 2008;74(5):501-3.

Orlovic D, Smego RA. Hypercoagulability Due to Protein S Deficiency in HIV-Seropositive Patients. International Journal of Collaborative Research on Internal Medicine & Public Health (IJCRIMPH), 2009; 1(6&7):187-193.

Rajendran PM, Dolev JC, Heaphy MR, Maurer T. Eosinophilic Folliculitis: before and after the introduction of antiretroviral therapy. Arch Dermatol. 2005;141(10):1227-1231. UNAIDS update of the global HIV/AIDS Epidemic. December 2007.

Kadyada Puttaiah Srikanth

Mysore Medical College and Research Institute, India

Email: kpkantha@gmail.com

Sunith Vijayakumar

Mysore Medical College and Research Institute, India

Email: drsunithvijay@gmail.com

Aparna

Mysore Medical College and Research Institute, India

Email: draparna.chethan@gmail.com

Mallikarjun

Department of Skin and STD

Bangalore Medical College and Research Institute, India

Email: drmkdermas@yahoo.com
Table 1: Distribution of the study population according to age,
gender, occupation and marital status

   Variable                  Male               Female
  Age (years)                n=182               n=168

     16-20        (3.8%)       7      (4.2%)       7
     21-25        (7.6%)      14      (20.8%)     35
     26-30        (23.1%)     42       (25%)      42
     31-35        (30.8%)     56      (29.2%)     49
     36-40        (11.5%)     21      (4.2%)       7
     41-45        (15.3%)     28      (8.3%)      14
     46-50        (7.6%)      14      (8.3%)      14
     Total         (52%)      182      (48%)      168

Occupation

    Skilled       (26.9%)     49      (16.6%)     28
  Semiskilled     (23.1%)     42      (4.1%)       7
   Unskilled      (23.1%)     42       (75%)      126
  Agriculture     (26.9%)     49      (4.2%)       7

Marital Status

    Married       (73.1%)     133     (45.8%)     77
   Unmarried      (26.9%)     49      (4.2%)       7
     Widow                    --      (45.8%)     77
   Separated                  --      (4.2%)       7

   Variable                  Total
  Age (years)                n=350

     16-20         (4%)       14
     21-25         (14%)      49
     26-30         (24%)      84
     31-35         (30%)      105
     36-40         (8%)       28
     41-45         (12%)      42
     46-50         (8%)       28
     Total                    350

Occupation

    Skilled        (22%)      77
  Semiskilled      (14%)      49
   Unskilled       (48%)      168
  Agriculture      (16%)      56

Marital Status

    Married        (60%)      210
   Unmarried       (16%)      56
     Widow         (22%)      77
   Separated       (2%)        7

Table 2: Prevalence of the viral opportunistic infections (OIs) among
cat-1 (non-HAART) study population with mean CD4+Count

     Disease           Male        Female       Total
                      (n=84)       (n=91)      (n=175)
Herpes Zoster               7           21           28
(HZ)                  (8.3%)      (23.1%)       (16%)

Condyloma                   35          --            35
acuminatum           (41.7%)                   (20.0%)

HSV genitalis                7           21           28
                      (8.3%)      (23.1%)       (16%)

Verruca Vulgaris           --             7            7
                                   (7.7%)       (4.0%)

Molluscum                  21           21           42
contagiosum           (25%)       (23.1%)       (24%)

Total                      70           70          140
                     (83.3%)      (76.9%)       (80%)

     Disease             Mean CD4+Count

Herpes Zoster         273.2 [+ or -] 149.39
(HZ)

Condyloma              197 [+ or -] 177.53
acuminatum

HSV genitalis         211.5 [+ or -] 150.46

Verruca Vulgaris       368 [+ or -] 150.82

Molluscum             155.1 [+ or -] 123.42
contagiosum

Total                 240.96 [+ or -] 82.69

Table 3: Prevalence of the viral OIs among cat-2 (under-HAART) study
population with mean CD4+Count

Disease                Male       Female       Total
                      (n=98)      (n=77)      (n=175)

Herpes Zoster                          14          14
(HZ)                              (18.1%)      (8%)

Condyloma                   14         --           14
acuminatum            (14.2%)                  (8%)

HSV genitalis              --            7           7
                                    (9.1%)        (4%)

HSV labialis               --            7           7
                                  -(9.1%)      -(4%)

Verruca Vulgaris         7           7          14
                        (7.1%)      (9.1%)        (8%)

Total                      21          35          56
                      (21.4%)     (45.4%)      (32%)

Disease                   Mean CD4+Count

Herpes Zoster           56 [+ or -] 24.25
(HZ)

Condyloma              319 [+ or -] 227.39
acuminatum

HSV genitalis          282 [+ or -] 132.14

HSV labialis            105 [+ or -] 81.12

Verruca Vulgaris       105.5 [+ or -] 89.3

Total                 173.50 [+ or -] 118.39

Table 4: Prevalence of the bacterial OIs among cat-1 (non-HAART) study
population with mean CD4+Count

Disease           Male       Female       Total
                 (n=84)      (n=91)      (n=175)

Furuncle              --            7           7
                             (7.6%)       (4%)

Carbuncle             --            7           7
                             (7.6%)       (4%)

Folliculitis          --            7           7
                             (7.6%)       (4%)

Abscess               --            7           7
                             (7.6%)       (4%)

Syphilis                7         --            7
                 (8.3%)                   (4%)

Total                   7          28          35
                 (8.3%)      (30.8%)     (20.0%)

Disease              Mean CD4+Count

Furuncle            86 [+ or -] 3.35

Carbuncle           146 [+ or -] 3.74

Folliculitis        136 [+ or -] 3.89

Abscess             69 [+ or -] 8.79

Syphilis            280 [+ or -] 4.18

Total             143.40 [+ or -] 82.99

Table 5: Prevalence of the bacterial OIs among cat-2 (under-HAART)
study population with mean CD4+Count

Disease            Male        Female       Total
                  (n=98)       (n=77)      (n=175)

Furuncle                 7           14           21
                  (7.1%)      (18.2%)       (12%)

Carbuncle              --            -            -

Folliculitis            14            7           21
                 (14.2%)       (9.1%)       (12%)

Total                   21           21           42
                 (21.4%)      (27.3%)       (24%)

Disease             Mean CD4+Count

Furuncle         336.6 [+ or -] 124.36

Carbuncle

Folliculitis      124 [+ or -] 98.54

Total             230 [+ or -] 150.33

Table 6: Prevalence of the Fungal OIs among cat-1 (non-HAART) study
population with mean CD4+Count

Disease                Male        Female       Total
                      (n=84)       (n=91)      (n=175)

Tinea                        7            7           14
                      (8.3%)       (7.6%)        (8%)

Onychomycosis                7          --             7
                      (8.3%)                     (4%)

Pityriasis                   7          --             7
versicolor            (8.3%)                     (4%)

Oral candidiasis            35           14           49
                     (41.6%)      (15.3%)       (28%)

Total                       56           21           77
                     (66.6%)      (23.1%)       (49%)

Disease                 Mean CD4+Count

Tinea                  79 [+ or -] 30.61

Onychomycosis          22 [+ or -] 3.21

Pityriasis             46 [+ or -] 4.82
versicolor

Oral candidiasis      150.8 [+ or -] 98.3

Total                  74.45 [+ or -] 56

Table 7: Prevalence of the Fungal OIs among cat-2 (under-HAART) study
population with mean CD4+Count

       Disease            Male       Female       Total
                         (n=98)      (n=77)      (n=175)

        Tinea                  42          21          63
                         (48.9%)     (27.3%)      (36%)

    Onychomycosis             --            7          63
                                     (9.1%)       (4%)

Pityriasis versicolor         --          --          --

  Oral candidiasis            --          --          --

        Total                  42          28          70
                         (48.9%)     (36.4%)      (40%)

       Disease              Mean CD4+Count

        Tinea            133.35 [+ or -] 125.7

    Onychomycosis         112 [+ or -] 40.76

Pityriasis versicolor

  Oral candidiasis

        Total            122.68 [+ or -] 15.09

Table 8: Prevalence of the non-infectious skin lesions among cat-1
(non-HAART) study population with mean CD4+Count

     Disease          Male       Female       Total
                     (n=84)      (n=91)      (n=175)

     Xerosis               14         --           14
                     (16.7%)                  (8%)

  Eosinophillic           --          14          14
  folliculitis                   (15.4%)      (8%)

   Seborrhoeic            14          --          14
   dermatitis        (16.7%)                  (8%)

 Aphthous ulcer           --          14            7
                                 (7.7%)       (4%)

 Photodermatitis          --          14           14
                                 (15.4%)      (8%)

Pityriasis rosea            7         --            7
                     (8.3%)                   (4%)

      Total                 7           7           7
                     (41.7%)     (38.5%)      (40%)

     Disease             Mean CD4+Count

     Xerosis            40 [+ or -] 24.04

  Eosinophillic        199 [+ or -] 106.12
  folliculitis

   Seborrhoeic         95.5 [+ or -] 58.54
   dermatitis

 Aphthous ulcer        172 [+ or -] 70.23

 Photodermatitis        87 [+ or -] 69.3

Pityriasis rosea       502 [+ or -] 150.33

      Total            182.58 [+ or -] 167

Table 9: Prevalence of the non-infectious skin lesions among cat-2
(under HAART) study population with mean CD4+Count

       Disease            Male       Female       Total
                         (n=98)      (n=77)      (n=175)

       Xerosis                 14           7          21
                         (14.2%)     (9.1%)       (12%)

     Seborrhoeic              14          21          35
     dermatitis          (14.2%)     (27.2%)      (20%)

    Eosinophillic              7          --           7
    folliculitis         (7.1%)                   (4%)

   Aphthous ulcer              7          --           7
                         (7.1%)                   (4%)

  Pruritic papular             7          21           28
      eruptions          (7.1%)      (27.2%)      (16%)

Drug reaction

   Nevirapine rash             7          --           28
                         (28.6%)                  (16%)

      Lichenoid                7            7          14
      eruption           (7.1%)      (9.1%)       (8%)

  Actinic chelitis            --            7           7
                                     (9.1%)       (4%)

  Contact allergic             7          --            7
     dermatitis          (7.1%)                   (4%)

        Total                  91          63         154
                         (92.9%)     (81.8%)      (88%)

       Disease                 Mean CD4+Count

       Xerosis              35.3 [+ or -] 14.15

     Seborrhoeic            74.6 [+ or -] 46.77
     dermatitis

    Eosinophillic            44 [+ or -] 28.54
    folliculitis

   Aphthous ulcer            249 [+ or -] 50.11

  Pruritic papular          94.25 [+ or -] 15.08
      eruptions

Drug reaction

   Nevirapine rash          83.75 [+ or -] 24.43

      Lichenoid              56 [+ or -] 39.29
      eruption

  Actinic chelitis            7 [+ or -] 2.13

  Contact allergic            8 [+ or -] 4.22
     dermatitis

        Total               78.7 [+ or -] 79.35

Table 10: Comparison of prevalence of viral OIs in Cat-1 and Cat-2

                              n=175               n=175
      Disease           Cat-1 (non-HAART)      Cat-2 (HAART)

 Herpes Zoster (HZ)                28                     14
                        (16%)               (8%)

     Condyloma                     35                14 (28.57%)
     acuminatum         (20%)               (8%)

   HSV genitalis                   28                  7 (20%)
                        (16%)               (4%)

    HSV Labialis                   --        -4%          7

  Verruca Vulgaris                  7                 14 (66.6%)
                        (4%)                (8%)

     Molluscum                     42
    contagiosum         (24%)                             --

       Total                       140                    56
                        (80%)               (32%)

                                  n=350
      Disease                     Total

 Herpes Zoster (HZ)                42
                        (12%)

     Condyloma                     49
     acuminatum         (14%)

   HSV genitalis                   35
                        (10%)

    HSV Labialis        (2%)        7

  Verruca Vulgaris                 21
                        (6%)

     Molluscum                     42
    contagiosum         (12%)

       Total                       196
                        (56%)

Table 11: Comparison of prevalence of bacterial OIs in Cat-1 and Cat-2

   Disease              n=175              n=175         n=350
                 Cat-1 (non-HAART)     Cat-2 (HAART)     Total

   Furuncle                     7        21                 28
                   (4%)               (12%)      (8%)

  Carbuncle        (4%)         7        --      (2%)        7

 Folliculitis                   7        21                 28
                   (4%)               (12%)      (8%)

   Abscess         (4%)         7        --      (2%)        7

   Syphilis        (4%)         7        --      (2%)        7

    Total                      35        42                 77
                  (20%)               (24%)     (22%)

Table 12: Comparison of prevalence of Fungal OIs in Cat-1 and Cat-2

       Disease                 n=175               n=175       n=350
                         Cat-1 (non-HAART)    Cat-2 (HAART)    Total

        Tinea                        14       63                 77
                          (8%)               (36%)    (22%)

    Onychomycosis         (4%)       7      7 (4%)     (4%)      14

Pityriasis versicolor     (4%)       7        --       (2%)      7

   Oral candidiasis       (28%)      49       --      (14%)      49

        Total                        77       70                147
                          (44%)              (40%)    (42%)

Table 13: Comparison of the prevalence of the non-infectious lesions
among cat-1 and cat-2

                                  n=175          n=175        n=350
          Disease              Cat-1(non-    Cat-2(HAART)     Total
                                 HAART)

          Xerosis                      14              21         35
                                  (8%)           (12%)        (10%)
 Eosinophilic folliculitis             14               7         21
                                  (8%)           (4%)          (6%)
   Seborrhoeic dermatitis              14              35       42
                                  (8%)           (20%)        (12%)
       Aphthous ulcer                   7               7         14
                                  (4%)           (4%)          (4%)
      Photodermatitis                  14                         14
                                  (8%)                         (4%)
      Pityriasis rosea                  7                          7
                                  (4%)                         (2%)
 Pruritic papular eruption                             28         28
           (PPE)                                 (16%)         (8%)
       Drug reaction                                   42         42
                                                 (24%)        (12%)
      Actinic chelitis                                  7          7
                                                 (4%)          (2%)
Contact allergic dermatitis                             7          7
                                                 (4%)          (2%)
           Total                       70             154        224
                                  (40%)          (88%)        (64%)
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Article Details
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Author:Srikanth, Kadyada Puttaiah; Vijayakumar, Sunith; Aparna; Mallikarjun
Publication:International Journal of Collaborative Research on Internal Medicine & Public Health (IJCRIMPH)
Article Type:Clinical report
Geographic Code:9INDI
Date:Mar 1, 2010
Words:5345
Previous Article:A study on tuberculous pleural effusion.
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