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STUDIES
Year : 1992  |  Volume : 58  |  Issue : 3  |  Page : 155-158

Clinical profile of HIV infection




Correspondence Address:
Uday Khopkar


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Source of Support: None, Conflict of Interest: None


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  Abstract 

HIV seropositivity rate of 14 percent was observed amongst STD cases. Heterosexual contact with prostitutes was the main risk factor. Fever, anorexia, weight loss, lymphadenopathy and tuberculosis were useful clinical leads. Genital ulcers, especially chancroid, were common in seropositivies. Alopecia of unknown cause, atypical pyoderma, seborrhea, zoster, eruptive mollusca and sulfa-induced erythema multiforme were viewed with suspicion in high risk groups. Purpura fulminans, fulminant chancroid, vegetating pyoderma and angioedema with purpura were unique features noted in this study.


Keywords: HIV Infection


How to cite this article:
Khopkar U, Raj S, Sukthankar A, Kulka. Clinical profile of HIV infection. Indian J Dermatol Venereol Leprol 1992;58:155-8

How to cite this URL:
Khopkar U, Raj S, Sukthankar A, Kulka. Clinical profile of HIV infection. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Mar 25];58:155-8. Available from: http://www.ijdvl.com/text.asp?1992/58/3/155/3784



  Introduction Top


Human Immunodeficiency Virus (HIV) has taken the world by storm and India is no exception. By the end of 1991 the estimated HIV seropositives in India had gone up to 2.5 to 10 lakh. [1] Estimates of AIDS cases in India run in thousands. [1] Majority of the cases are from Maharashtra, Tamil Nadu and Manipur. HIV and Hepatitis B virus share the distinction of being sexually transmitted and resulting in grave systemic consequences. This gives the STD specialists a unique positional advantage in identifying asymptomatic HIV carriers. This study of 104 HIV seropositives aimed at identifying clinical leads for detection of HIV infection.


  Materials and Methods Top


Seven hundred and fifty patients attending a skin and STD outdoor, 95 percent of them with a history of promiscuity, were screened. Detailed history and clinical examination were followed by serum VDRL test and serum ELISA for HIV. Positive results were confirmed by a repeat ELISA and a Western Blot test or a third ELISA on a fresh blood sample. Follow up of seropositives averaged 2 months, the maximum being 2 years.


  Results Top


Fourteen percent (104) of the patients screened were HIV seropositive. Most of them were young adult males (M:F7:1, mean age 26 yrs). Only a minority (10 percent) were married. Majority (91 percent) were from the lower socioeconomic group. Risk factors noted were multiple unprotected heterosexual contacts with prostitutes in 85 patients, homosexuality in 7, prostitution in 5, wife of seropositive in 3, drug abuse in 1, and no known risk factors in 3.

STDs encountered in 83 percent of seropositives are listed in [Table - 1]. More than one STD was present in only 3 patients. Poor response to commonly used antibiotics was observed in 5 (17 percent) cases of chancroid. One such patient of phagedenic chancroid progressed to develop a urethral fistula. [Figure - 1] Another unusual observation in 3 cases was fulminant chancroid of the inner surface of prepuce bursting through to the outer surface leaving the glans exposed through a pathologic opening. [Figure - 2]

Diffuse alopecia was the most common skin lesion [Table - 1]. Atypical pyoderma was seen as vegetating lesions, crusted hypertrophic plaques, unresponsive sycosis barbae and folliculitis in one patient each. One case presented with recurrent zoster, whereas another presented with eruptive mollusca involving non-genital regions. [Figure - 3]. Erythroderma with lymphadenopathy, alopecia and constitutional symptoms suggested primary HIV infection in,a iady. Erythema multiforme induced by co-trimoxazole was observed in one middle-aged male. Purpura fulminans, probably precipitated by gonococcemia, led to the uncovering of HIV infection in a male. Uncontrolled infection of the skin ulcers led to septicaemia and death in this patient. Another unusual finding was an episode of angioedema accompanied by purpura involving all four extremities in an adult male that responded to systemic steroids and antihistamines.

Fever, weight loss and anorexia were the most frequent systemic features, seen in about 10 percent of cases [Table - 2]. Lymphadenopathy involving more than one non-inguinal sites, though a presenting complaint in one, was usually discovered only after examination. Pulmonary tuberculosis was detected in 3, whereas 2 cases had frequent diarrhoea but no organisms were found on stool analysis.


  Comments Top


The 14 percent HIV seropositivity rate amongst STD cases in this study is the highest reported from India. Prior studies report rates of 2 to 5 percent in promiscuous heterosexual mates. [1],[2] The main risk factor was multiple heterosexual contacts with prostitutes. This confirms the view that HIV spreads mainly through heterosexual contact in India. Although in this study only promiscuous cases were included, such high seropositivity rate underscores the importance of routine screening of STD cases for HIV. It also focuses on the major role that STD specialists have in prevention of HIV infection. The absence of known risk factors in 3 cases underlines the need to screen a patient for HIV if clinical suspicion is high.

STDs constitute majority of infections in these promiscuous males. Their pattern was dominated by genital ulcerative disease (59 percent), majority of which were chancroid and genital herpes. Chancroid and condyloma acuminata tended to be less responsive to routine therapy. Thus non-responsiveness may suggest underlying HIV infection. Fulminant perforating chancroid exposing the glans through a pathologic opening was a unique feature.

Atypical morphology of pyoderma in 2 patients and eruptive mollusca and recurrent zoster in one each led to the detection of HIV seropositivity. This is in contrast to diffuse alopecia and seborrhoea which were never the presenting complaints. The morphology of mollusca was typical but the non-genital distribution in adults suggested HIV. [3] The presentation of one case with erythroderma, lymphadenopathy, fever and constitutional features was similar to that recently reported by Janniger et al. [4] The frequency of constitutional symptoms and signs and lymphadenopathy makes it imperative for them to be viewed with suspicion in high risk individuals. The detection of pulmonary tuberculosis in 3 patients confirms the view that it may be a common systemic infection in HIV seropositives in India. [5]

The sad scenario of HIV infection is summed up in the WHO estimate that 3 million women and children, mainly from the developing countries, will die in the 90's of HIV disease [6] Case detection and health education are presently the only ways to combat this catastrophe. This study was an attempt to evolve leads for case detection.

 
  References Top

1.Lal S. HIV-AIDS situation in India. CARC Calling 1991; 4 : 36 - 8.  Back to cited text no. 1    
2.Editorial. HIV Infection- Current status and future research plans. ICMR Bulletin 1991; 21 : 125-44.  Back to cited text no. 2    
3.Petersen C S, Gerstoft J. Molluscum contagiosum in HIV infected patients. 1992; 184: 19-21.  Back to cited text no. 3    
4.Janniger C K, Gascon P, Schwartz R A, et al. Erythroderma as the initial presentation 'of acquired immunodeficiency syndrome. Dermatologica 1991; 183: 143 - 5.  Back to cited text no. 4    
5.Sengupta S R. Tuberculosis and human immunodeficiency virus infection. CARL Calling 1989; -2: 22 - 4.  Back to cited text no. 5    
6.Dover J S, Johnson R A. Cutaneous manifestations of human immunodeficiency virus infection. Arch Dermatol 1991; 127 : 1383 - 91.  Back to cited text no. 6    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

    Tables

[Table - 1], [Table - 2]

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3 Skin lesions in HIV-positive and HIV-negative patients in South India
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