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Dermatology
Cutaneous Manifestations of HIV Infection
Built from Dermatology, 5th Edition
What’s inside
8 sections · 133 slides
Overview
- What this topic covers
- Key features
History, Epidemiology, and Pathogenesis
How HIV was discovered, who it affects worldwide, and how it damages immunity
- Discovery of HIV/AIDS
- Early milestones in treatment
- Global prevalence of HIV infection
- How many people are affected
- Who is most affected
- What kind of virus is HIV
- HIV-1 versus HIV-2
- Replication of HIV within a CD4+ lymphocyte
- How HIV enters and hijacks a cell
- Viral load and immune response over the course of HIV-1 infection
- The course of untreated infection
- Not everyone follows the typical course
- Chronic immune activation and AIDS
- Why staging and CD4+ counts matter
- WHO clinical staging of HIV/AIDS
- WHO clinical staging of HIV/AIDS (continued)
- WHO clinical staging of HIV/AIDS (continued)
- CD4+ cell count and HIV-associated disorders
- CD4+ cell count and HIV-associated disorders (continued)
- CD4+ cell count and HIV-associated disorders (continued)
- CD4+ cell count and HIV-associated disorders (continued)
- CD4+ cell count and HIV-associated disorders (continued)
HIV-Related Infectious Skin Conditions
Viral, bacterial, fungal, and parasitic infections that behave differently once immunity is impaired
- Why infections behave differently in HIV
- Primary HIV infection (acute retroviral syndrome)
- Herpes simplex virus (HSV) infection
- Chronic ulcerative HSV infection
- Two unusual patterns of HSV disease
- Testing and treating resistant HSV
- Varicella and herpes zoster
- Chronic herpes zoster in a patient with HIV
- Molluscum contagiosum
- Treating molluscum in HIV
- Human papillomavirus (HPV) infections
- HPV-related cancer risk
- Treating HPV lesions
- Oral hairy leukoplakia (OHL)
- Oral hairy leukoplakia: clinical and histologic appearance
- Oral hairy leukoplakia of the tongue
- Cytomegalovirus (CMV) infection
- Disseminated CMV infection with cutaneous ulceration
- Bacterial skin infections in HIV
- Necrotizing fasciitis in a patient with HIV
- Staphylococcus aureus infections
- Bacillary angiomatosis
- Mycobacterial skin infections
- Syphilis
- Secondary syphilis presenting as lues maligna
- Fungal infections in HIV
- Candidiasis
- Oral herpes simplex virus infection and oral candidiasis
- Dermatophyte (ringworm) infections
- Disseminated cryptococcosis
- Disseminated dimorphic fungal infections
- Disseminated histoplasmosis
- Pneumocystis jirovecii infection
- Other fungal and related infections
- Leishmaniasis
- Treating leishmaniasis in HIV
- Strongyloidiasis
- Acanthamebiasis
- Scabies
- Crusted scabies in HIV infection
- Treating scabies, and other mite/insect problems
Non-Infectious HIV-Related Dermatoses
Inflammatory, itchy, and metabolic skin problems linked to HIV and its treatment
- A pattern-recognition table
- Mucocutaneous disorders associated with HIV infection
- Mucocutaneous disorders associated with HIV infection (continued)
- Mucocutaneous disorders associated with HIV infection (continued)
- Seborrheic dermatitis
- Psoriasis in HIV
- Severe psoriasis in AIDS
- Extensive skin and nail psoriasis
- Treating HIV-associated psoriasis
- Reactive arthritis
- Other eczema-like and scaly disorders
- Why itchy papules are so common in HIV
- Pruritic papular eruption (PPE) of HIV
- Eosinophilic folliculitis
- Hair changes in HIV
- Nail changes in HIV
- Vasculitis in HIV
- Cutaneous vasculitis in HIV
- Photosensitivity reactions
- Photolichenoid eruption in HIV
- Porphyria cutanea tarda and chronic actinic dermatitis
- HIV/ART-associated lipodystrophy
- Lipoatrophy versus lipohypertrophy
- Managing lipodystrophy
- Weight gain and malnutrition
- Miscellaneous dermatoses
- Granuloma annulare in a patient with HIV
- Major aphthous ulcers
HIV-Related Cutaneous Neoplasms
Skin cancers linked to immune suppression, viral co-infection, and prolonged survival on ART
- Why HIV raises cancer risk
- Kaposi sarcoma (KS)
- Kaposi sarcoma of the mouth and genitalia
- Kaposi sarcoma of the trunk and lower limb
- Managing Kaposi sarcoma
- Keratinocyte carcinomas and melanoma
- Lymphomas
- Other cutaneous neoplasms
Differential Diagnosis and Diagnosis
Using CD4+ count to narrow the differential, and how HIV itself is confirmed in the laboratory
- Approaching a puzzling rash in HIV
- Working up a skin lesion
- How HIV infection itself is diagnosed
- Home and point-of-care testing
- Laboratory tests for HIV infection
Antiretroviral Therapy and Its Complications
How ART works, why it is started early, and the skin problems it can cause or unmask
- How antiretroviral therapy (ART) works
- Choosing a first-line regimen
- Preventing HIV transmission
- Other prevention strategies
- What is IRIS
- How IRIS happens
- Leprosy flare as a manifestation of IRIS
- Which diseases can flare as IRIS
- Cutaneous diseases that can flare due to IRIS
- Cutaneous diseases that can flare due to IRIS (continued)
- Drug-drug interactions
- Drug eruptions are common in HIV
- Cutaneous side effects of antiretroviral therapy, by drug class
- Trimethoprim-sulfamethoxazole (TMP-SMX) reactions
- Managing drug eruptions
- Key takeaways
References
Sources cited in this chapter
- References
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)