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Clinical Study on Dermatological Presentation in 100 Cases of Hiv Infection

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Clinical Study on Dermatological Presentation in 100 Cases of Hiv Infection CLINICAL STUDY ON DERMATOLOGICAL PRESENTATION IN 100 CASES OF HIV INFECTION DISSERTATION Submitted To the Tamilnadu Dr.M.G.R. Medical University In Partial Fulfilment Of The Requirements For The Award Of Degree Of M.D. BRANCH XІІ A (Dermatology, Venereology and Leprosy ) DEPARTMENT OF DERMATOLOGY, VENEREOLOGY & LEPROSY COIMATORE MEDICAL COLLEGE COIMBATORE-641014 THE TAMILNADU DR.M.G.R.MEDICAL UNIVERSITY CHENNAI – TAMILNADU APRIL – 2011 CERTIFICATE This is to certify that this dissertation entitled “CLINICAL STUDY ON DERMATOLOGICAL PRESENTATION IN 100 CASES OF HIV INFECTION” is a bonafide work done by DR. LINCY C.F, Post Graduate in M.D. Dermatology, Venereology and Leprosy, Coimbatore Medical College, Coimbatore- 641014, during the academic year 2009-2010. This work was done under my direct guidance and supervision and submitted for the M.D.BRANCH XІІ A examination in April 2011 to the Tamil Nadu Dr.M.G.R. Medical University, Chennai. Dr.R.VIMALA, M.D. Dr.P.P. RAMASAMY, M.D., D.D., DEAN, Professor and Head of the Department, Coimbatore Medical College, Department of Dermatology & Leprosy, Coimbatore- 641014 Coimbatore Medical College, Coimbatore - 641014 DECLARATION I Dr.LINCY C.F, solemnly declare that this dissertation titled “CLINICAL STUDY ON DERMATOLOGICAL PRESENTATION IN 100 CASES OF HIV INFECTION” is a bonafide work done by me at Coimbatore Medical College during 2009-2010 under the guidance and supervision of Prof. Dr.P.P.Ramasamy, M.D., D.D., Professor and Head, Department of Dermatology, Coimbatore Medical College, Coimbatore- 641014. This dissertation is submitted to The Tamilnadu Dr. M.G.R Medical University, towards partial fulfilment of requirement for the award of M.D. Degree in Dermatology, Venereology and Leprosy (Branch XII A). Place: Coimbatore. DR. LINCY. C. F Date: SPECIAL ACKNOWLEDGEMENT My sincere thanks to Dr. R.VIMALA M.D. DEAN, Coimbatore Medical College, Coimbatore, for allowing me to do this dissertation and utilize the institutional facilities. My sincere gratitude to Dr. A.MATHIVANAN M.S,DCH., Medical Superintendent, Coimbatore Medical College, Coimbatore, for allowing me to do this dissertation and utilize the institutional facilities. ACKNOWLEDGEMENT I am gratefully indebted to Dr..P.P Ramasamy M.D., D.D., Professor and Head, Department of Dermatology and Leprosy for his invaluable guidance, motivation and help throughout the study. I express my gratefulness to Associate Prof. Dr.K.Kannaki, M.D.,D.D., Department of Dermatology for her constant motivation and guidance. My sincere thanks to Dr.Thilagavathy,M.D.,D.V., Professor and Head, Department of Venereology, for her help and suggestions and to my former Professor Dr.G.Srinivasan M.D.,D.V., for his advice. I would like to express my sincere and heartful gratitude to Dr.K.Mahadevan, M.D., D.V., Reader, Department of Venereology for his kind help. I wish to thank former Asst. Prof. Dr.R.Muthukumaran, M.D., Tutor in Leprosy for his constant support and motivation. I thank Dr.M.Revathy, M.D., Asst. Professor, Department of Dermatology for her benevolent help and support. I am very grateful to Dr.B.Eswaramurthi, M.D., Asst.Professor, Department of Dermatology for his invaluable guidance and help. I am also thankful to Dr.R.Madhavan M.D., Asst.Professor, for his continuing guidance and support. I am also thankful to Dr.N.Kurinjipriya M.D., Tutor in leprosy for her support. I am also grateful to ART Medical officers for their kind support and timely help. I am also grateful to my colleagues and paramedical workers for the support and timely help. A special mention of thanks to the patients for their co-operation without whom this study would not have been possible. CONTENTS SL TITLE PAGE NO NO. 1. INTRODUCTION 1 2. LITERATURE REVIEW 3 3. AIM OF STUDY 43 4. MATERIALS AND METHODS 44 5. OBSERVATIONS AND RESULTS 46 6. DISCUSSION 63 7. CONCLUSION 67 BIBLIOGRAPHY PROFORMA ABBREVIATIONS MASTER CHART KEY TO MASTER CHART Introduction INTRODUCTION Acquired immunodeficiency syndrome (AIDS) was recognized as a new disease for the first time in 1981. 1 AIDS was recognized because in March 1981 eight cases of more aggressive form of Kaposi’s Sarcoma had occurred amongst young gay men in New York and at the same time there was an increase in the number of cases of Pneumocystis Carinii pneumonia (PCP) in both California and New York. 2, 3 Despite the development of laboratory methods, dermatological symptoms were in the past and still are the basic indicators of presence and physical course of the disease; human immunodeficiency virus (HIV) infection and AIDS are frequently related to a wide range of skin and mucosal manifestations. 1 This ranges from macular, roseola like rash in the acute seroconversion syndrome to the extensive end-stage Kaposi’s Sarcoma. 4 In primary HIV infection manifestations like fever, joint pain and night sweats are non specific for identifying acute seroconversion, because in developing countries where other endemic diseases with similar complaints are common. 5, 6 In the developed countries, primary HIV-1 infection is estimated to be symptomatic in up to 80% of cases [Acute retroviral syndrome (ARS)] 7 with the advent of Highly Active Anti Retroviral Therapy, the course of HIV/AIDS has been significantly changed. In this study an attempt is made to find out the various dermatological manifestations associated with HIV/AIDS and to identify the most common predictor of HIV/AIDS in this part of the country. Literature Review LITERATURE REVIEW Epidemiology of HIV/ADIS : Ever since its recognition in 1981, HIV/ADIS Continues to ravage all the continents of the world. 8 More than 25 million people have died of AIDS since 1981. 9 World Wide Statistics: At the end of 2008, women accounted for 50% of all adults living with HIV worldwide. Africa has over 14 million AIDS orphans. The number of people living with HIV has risen from around 8 million in 1990 to 33 million today, and is still growing. Around 67% of people living with HIV/AIDS are in Sub Saharan Africa. In developing and transitional countries, 9.5 million people are in immediate need of life saving AIDS drugs; of these only 4 million (42%) are receiving the drugs. 9 TABLE 1 Worldwide statistics of people living with HIV/AIDS People Living with HIV/AIDS Estimate (million) in 2008 Adults 31.3 Women 15.7 Children 2.1 TABLE 2 World HIV/AIDS statistics European HIV and AIDS statistics: According to UNAIDS estimates, around 2.3 million people were living with HIV in Europe at the end of 2008. 10 The number of AIDS cases per million populations has declined slightly in western and central Europe, as a result of the widespread availability of antiretroviral drugs in this region. 11 South Africa National HIV survey 2008: 10.9% of all South Africans over 2 years old were living with HIV in 2008. Among females, HIV prevalence is highest in those between 25 and 29 years old; among males, the peak is in the group aged 30-34 years 12 . Antenatal surveillance is internationally recognized as the most useful way of assessing HIV prevalence among women aged 15-19 years old, for which the antenatal survey produce a rate much higher than the household survey (15.9% compared to 9.4%). 13 Sub-Saharan Africa HIV and AIDS Statistics: An estimated 22.4 million adults and children were living with HIV in Sub-Saharan Africa at the end of 2008. During that year an estimated 1.4 million Africans died from AIDS. Around 14.1 million children have lost one or both parents in the epidemic, and in 2008 an estimated 1.8 million children were living with HIV. 14 India HIV and AIDS statistics: India has a population of one billion, around half of whom are adults in the sexually active age group. The first AIDS case in India was detected in 1986 15 , and since then HIV infection has been reported in all states and union territories. The highest HIV prevalence rates are found in Andra Pradesh, Maharashtra, Tamil Nadu and Karnataka in the south and Manipur and Nagaland in the North-East. In the south states, HIV is primarily spread through heterosexual contacts. Infections in north-east are mainly found among injecting drug users (IDUs) and sex workers 16 . The average HIV prevalence among women attending antenatal clinics in India is 0.48% much higher rates found among people attending STD clinics, female sex workers (5.1%), Injecting drug users (7.2%) and men who have sex with men (7.4%) 17 Antiretroviral drugs (ARVs) which can significantly delay the progression from HIV to AIDS have been available in developed countries since 1996. In India an estimated 300,000 people were receiving free AVRs by January 2010. This represents less than half of those estimated to be in antiretroviral treatment in India. 18 HIV TRANSMISSION The primary routes of transmission are through sexual intercourse, vertically from mother to infant during pregnancy or early infancy, percutaneous exposure and exposure to infected blood and its products 29 . SEXUAL TRANSMISSION: Sexual transmission of HIV infection can occur following vaginal and anal intercourse, and also through oral sex. Male to female HIV transmission is twice as effective as female to male transmission 19 . The risk of male to female of HIV transmission during a single genital exposure has been calculated as less than 0.2% 20 . The risk of male to male transmission per episode of unprotected anal intercourse has been estimated to between 0.3% and 10%. 21 MOTHER TO CHILD TRANSMISSION (MTCT) HIV infection from an HIV positive mother to her child can occur during pregnancy, delivery or breast feeding 22 .
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