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MUCOCUTANEOUS MANIFESTATIONS OF HIV

AT-A-GLANCE

  • HIV is a retrovirus that causes immune suppression and dysregulation primarily via depletion of CD4+ lymphocytes and CD4+ cells of monocytic lineage.

  • In spite of better screening programs, availability of antiretroviral therapy (ART), and improved side-effect profiles, new infections continue to be documented.

  • The range of dermatologic complications seen in HIV/AIDS relates to the evolving immunologic state of the patient, specific viral characteristics of the serotype causing infection, the period of time from infection to dermatologic complication, and the length of antiretroviral treatment.

  • Acute HIV infection presents as a mononucleosis-like syndrome that can include a morbilliform exanthem 3 to 6 weeks after infection with HIV.

  • In resource-limited areas, untreated infection may lead to progressive dermatologic disease.

  • In reconstituted individuals and long-term viral suppression, sun-induced neoplasia and viral-induced neoplasia are significant burdens.

AN OVERVIEW OF HIV INFECTION

According to the World Health Organization (WHO), by the end of 2015, 36.7 million people worldwide were living with the HIV, lymphotropic human retrovirus. Approximately 2.1 million of those were newly diagnosed that year, and approximately 1.1 million died from complications of AIDS. CD4 count parameters that serve as guidelines for the initiation of treatment have increased from less than 200 cells/µL in 2003 to 500 cells/µL in 2011. As of 2015, all newly diagnosed HIV patients are candidates for antiretroviral therapy (ART); upwards of 30 million people will be eligible for treatment.1 Nevertheless, infections continue to occur both locally and abroad despite prevention programs and newly developed recommendations from the ­Centers for Disease Control and Prevention for optout screening in all health care settings in the absence of written consent for screening.2 These figures suggest that whereas progress has been made, a significant number of infections continue to occur, and the burden of disease will continue to exist as infected individuals live longer. Consequently, identification of HIV infection-­associated diagnoses is relevant in both resource-limited settings and in resource-abundant zones. The field of HIV medicine continues to rapidly evolve, and excellent internet resources that are frequently updated include the U.S. Department of Health and Human Services’ AIDSinfo (https://aidsinfo.nih.gov) and the Centers for ­Disease Control and Prevention’s National Prevention ­Information Network (https://npin.cdc.gov/).

ETIOLOGY AND PATHOGENESIS

HIV is predominantly transmitted through sexual contact. Other important means of transmission include exposure to infected blood (including needles shared by injecting drug users and “skin popping”) and transmission from an infected mother to her fetus during pregnancy, delivery, or breastfeeding. HIV-1 is the most common cause of HIV infection globally, while HIV-2 infection has been detected mainly in West Africa. Although both HIV subtypes cause clinically similar disease, HIV-2 is associated with slower progression of immunosuppression, decreased infectivity, and resistance to nonnucleoside reverse transcriptase inhibitors.3

The profound immunosuppression that defines HIV disease results from progressive depletion of CD4+ T lymphocytes. Efficient infection ...

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