Cutaneous Manifestations of HIV Disease PDF

PREFACE

Skin diseases are common problems in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). In many cases, the Dermatologist may be the first medical professional to encounter an individual with HIV infection. It is, therefore, vital that Dermatolo - gists recognize the cutaneous manifestations of HIV infection and AIDS so that the diagnosis can be established as early as possible and appropriate therapy can be instituted soon thereafter. In times past, this was important to lessen the likelihood of a patient developing a life-threatening opportunistic infection. Today, following diagnosis of HIV infec - tion, highly active antiretroviral therapy (HAART) is instituted, which can essentially eradi cate HIV viral loads, rendering them undetectable and significantly lessening the patient's chance of developing a complication, infectious or otherwise. Many different skin disorders may be seen in these patients ranging from infections such as lues and mycobacterial infections, to other inflammatory conditions such as drug eruptions, psoriasis, and sarcoidosis. Depending on the patient's immune status, skin disorders may appear similar to those seen in immunocompetent patients or they may be unusual and bizarre especially when CD4 cell counts are low. In any event, the skin is a very common site where diseases are manifest in HIV infected patients and any medical professional who takes care of these individuals must be cognizant of these manifestations and know how to manage them.

Fortunately, HAART has transformed HIV infection and AIDS so that patients are living longer with less sequelae today than when the AIDS pandemic was rampant. Unfortunately, in some populations, individuals have developed a ‘cavalier' attitude about HIV infection thinking, erroneously, that if they become infected, they can be ‘cured' by simply taking HAART. While indeed, ‘highly active', these medications do have side-effects and are not a cure for HIV infection. Thus, while the number of patients who present with severe infectious complica - tions or profoundly depressed CD4 cell counts is lower than in the past, there are still a significant number of individuals who are newly-infected with HIV each year and who may present with severe immunosuppression and even life-threaten ing oppor - tunistic infections. Clinicians cannot ‘lower their guard' and must maintain a high index of suspicion as HIV is still significantly endemic.

In this book, we cover the entire spectrum of HIVassociated cutaneous diseases and emphasize how they present in immunocompromised patients. Each entity is discussed in detail including its clinical presentation, histopathologic findings, and treat - ment. As Dermatology is a specialty that emphasizes morphology, numerous clinical and histopathological images are included in each chapter.

The book is written for any provider caring for HIV patients. It will also serve as an excellent reference for the experienced Dermatologist who may encounter these individuals either on occasion or frequently, and it will also serve as a reminder of some of the serious sequelae that may be encountered in severely immunocompromised patients.