Skin manifestation of Thai HIV infected patients in HAART era.

ABSTRACT

BACKGROUND: Skin and mucocutaneous disease changed its spectrum after Highly Active Antiretroviral Therapy (HAART) had been introduced. Previous publication showed opportunistic infections (OIs) related skin disease was a major presentation in pre-HAART era, whereas non-infected skin disease became emerging in HAART era. There is no report describing skin disease in HAART era among Thai HIV-infected patients. OBJECTIVE: To describe the prevalence of skin and mucocutaneous disease in Thai HIV-infected patients after using HAART MATERIAL AND METHOD: A cross-sectional retrospective study analyzed skin diseases of 237 HIV-infected patients who were currently on HAART who attended the out-patient skin clinic at Bamrasnaradura Infectious Diseases Institute between September 1, and October 31, 2010. There were 312 lesions. The skin diseases were diagnosed by dermatologists and grouped into four groups as infectious skin disease, non-infectious inflammatory skin disease, tumor and miscellaneous group. Percentage was calculated in each of skin disease prevalence. RESULTS: The results showed 155 (65%) were men, and mean (SD) of age was 41 (8.8). Median (IQR) of CD4 count was 330 (178, 527) cell/mm3. The regimens of HAART in the population were 79% for NNRTI based, 20% for PI based, and 1% for tripled NRTI. The time between initial HAART and date of diagnosis of most patients (52%) was more than three years. Non-infected skin disease (61%) was the most common skin disorder prevalence, followed by infectious disease (31%), tumor (0.96%), miscellaneous (6.09), respectively. The most common skin disease was eczema (21%). Four subjects developed drug eruption, all from Efavirenz. Atypical presentation specifically to HIV patients as chronic hypertrophic erosive herpes genitalis (one of IRIS) was found in four patients (20% of all HSV infectious prevalence). CONCLUSION: Non-infectious inflammatory skin disease is the most common skin prevalence in HIV-infected patients after receiving HAART Eczema was the most diagnosed skin disease. There were skin diseases related to immune restoration after using HAART and from HAART itself but in low prevalence.