Pattern of Cutaneous Pathology among a Cohort of HIV/AIDS Patients Accessing Care in a Rural/Suburban Adult ART Clinic in Nigeria

Abstract

Background: Cutaneous diseases are common in patients with HIV/AIDS however there are few documented reports of these lesions from some parts of world such as Nigeria and West Africa. Objective: The aim of this study was to identify cutaneous pathologies in patients attending an adult outpatient (HIV/AIDS) clinic department in a rural/suburban centre in the south geopolitical zone of Nigeria. Additionally it also aims to determine if there are differences in the pattern of presentation as compared to patients seen in other parts of the country and the world. Methods/Design: This is a prospective observational study conducted in the adult antiretroviral (ART) clinic of Irrua Specialist Teaching Hospital Irrua Edo StateNigeria over a 12 month period involving HIV positive patients. All patients with skin complaints are included in the study while other patients without skin complaints are generally excluded. Results: A total of 9460 patients were seen during this period in the clinic including old, new and repeat visits. Four hundred and ninety patients had various dermatologic complaints at various times giving a 5.18% prevalence of the cutaneous pathology. The mean age of the patients was 38±10 years with a male: female ratio of 1:1.4(140:350). For easy of analysis these lesions were grouped into infective and non-infective pathologies. Infective pathologies dominated the main manifestation (viral- 37.1%, fungal 24.3% and bacterial 2.9%) and non-infective mainly neoplasms 5.7%, drug reactions 11.4% and others 18.6% (comprising post inflammatory hypopigmentation and hyperpigmention, pruritic eruptions of HIV, and papularurticaria (insect bite reactions). Lesions are generally more florid and widespread in these patients particularly at lower CD4 counts. Conclusion: Cutaneous manifestations of HIV infection are common even when not deliberately sought out for. They range from infections to neoplasms and drug reactions. They can be the main reason for initial presentation to the clinic and without prompt recognition and treatment patients care will be incomplete.