Reviewing Dermatologic Manifestations of HIV Infection and Acquired Immunodeficiency Syndrome

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HIV infection and acquired immunodeficiency syndrome (AIDS) can be accompanied by a myriad of dermatologic conditions, including AIDS-specific skin eruptions, opportunistic infections, AIDS-related malignancies, and antiretroviral therapy (ART)-associated drug eruptions.

In a review published in the International Journal of Microbiology, authors Mohseni Afshar et al sought to explore the relationship between HIV and AIDS infection with various dermatoses using a review of relevant literature.

Investigators collected relevant data using PubMed, Google Scholar, and Scopus. All searches included full-text literature published until January 2023. As a result, they noted several mucocutaneous manifestations and categorized them by both ethiopathogenesis and specificity.

Papular pruritic eruption (PPE) is a prevalent dermatologic manifestation in HIV-infected patients, characterized by chronic symmetric papular eruptions on limbs, trunk, and face. The study highlights that lower CD4 cell counts correlate with increased pruritus and rash severity in PPE.

Xerosis, a result of lipid content decrease within the viable epidermis and dermis, leading to premature skin aging, is another common manifestation. Additionally, review authors note that eosinophilic folliculitis, prurigo nodularis, and papular mucinosis in patients with HIV and AIDS may also be common.

Over time, the evolution of ART has introduced the immune reconstitution inflammatory syndrome (IRIS), often manifested through skin involvement, authors wrote. Sexually transmitted diseases (STDs), intravenous drug user (IVDU)-associated complications, and poor lifestyle events are also discussed as potential contributors to cutaneous manifestations.

Opportunistic skin infections, including herpetic and mycobacterial infections, cryptococcosis, histoplasmosis, molluscum contagiosum, and bacillary angiomatosis, are also potential manifestations.

Reviewers also underscored the importance of recognizing that these infections may present differently in the context of AIDS.

Additionally, HIV may play a role in varying the clinical presentation of common dermatoses such as seborrheic dermatitis, atopic-like dermatitis, psoriasis, pityriasis rubra pilaris, Reiter's disease, and hidradenitis suppurativa, for example.

Beyond infectious and inflammatory conditions, the study explores metabolic diseases prevalent in HIV patients, emphasizing lipodystrophy as a hallmark of metabolic changes attributed to protease inhibitors use.

While the majority of HIV-related skin diseases are infectious or inflammatory, review authors acknowledged the occurrence of skin cancers, including Kaposi sarcoma, cutaneous lymphomas, and melanoma, especially in more advanced immunosuppression.

"Cutaneous manifestations in HIV-infected patients are quite various, ranging from AIDS-specific skin eruptions, opportunistic infections, IRIS-related skin manifestations, exacerbation or altered pattern of common dermatosis, nonopportunistic skin infections, ectoparasitic infestation, other STDs with dermatologic manifestations, IVDU and cutaneous complications, ART-associated drug eruptions to AIDS-related malignancies, and vasculitis," wrote Mohseni Afshar et al. "Most of the cutaneous disorders in the context of HIV/AIDS are managed easily in outpatient settings; however, some of them cause significant morbidity and mortality."

Reference

Mohseni Afshar Z, Goodarzi A, Emadi SN, et al. A comprehensive review on HIV-associated dermatologic manifestations: From Epidemiology to Clinical Management. Int J Microbiol. 2023;2023:6203193. Published 2023 Jul 18. doi:10.1155/2023/6203193