International Journal of General Medicine

and Pharmacy (IJGMP)

ISSN(P): 2319-3999; ISSN(E): 2319-4006
Vol. 4, Issue 1, Jan 2015, 5-14
© IASET

PREVALENCE OF DERMATOLOGICAL COMPLICATION AMONG HIV INFECTED ON

HAART PATIENTS –ACROSS SECTIONAL STUDY

REVATHI T. N., MALLIKAJUNA M & SANDYA

Department of Dermatology, Bangalore Medical College and Research Institute, Fort Road, Bangalore, India

ABSTRACT

Skin disorders are frequent among persons infected with HIV. Widespread introduction of HAART in mid 1990s
has altered the presentations of cutaneous manifestation associated with HIV infection. Our purpose was to evaluate the
use of HAART on the prevalence and spectrum of cutaneous manifestations in HIV-infected patients. Source of data will
consists of 100 HIV infected individuals/AIDS patients, 50 not on HAART and 50 “on HAART” attending skin and STD
clinics with symptoms and signs of dermatological disease. A brief questionnaire was asked according to proforma.
Clinical examination will include general examination followed by a detailed dermatological evaluation of the individual.
The present study shows significant decrease in overall infections in patients on HAART (54%) compared to
“non-HAART” (82%). Significant increase in inflammatory cutaneous disease in patients on HAART (60%) compared to
“non-HAART” (32%). Diagnoses of viral infections were 60% less frequent among those patients who had initiated
HAART. Fungal infections were 50% less frequent among those patients who had initiated HAART. Bacterial infections
showed no change due to the poor socioeconomic status of our population. Photo dermatitis is significantly more in
patients “on HAART” (12%). The prevalence of drug reactions was significantly higher in patients “on HAART” (26%)
compared to not on HAART (6%). Prevalence of STI is significantly reduced in patients “on HAART” (14%) compared to
not on HAART (28%). The incidence of most mucocutaneous manifestation decreased after starting HAART, the pattern
of decline was more pronounced for events with a viral etiology and for STIs. Cutaneous adverse reactions from
antiretroviral agents have become increasingly important to recognize as population of a patients surviving with
HIV infection grows. The decrease in the prevalence of skin disease can be an important motivator among persons
receiving HAART with regard to therapy adherence.

KEYWORDS: Human Immunodeficiency Virus (HIV) Highly Active Antiretroviral Therapy (HAART)

INTRODUCTION

Human Immunodeficiency Virus (HIV) is the etiologic agent of the Acquired Immunodeficiency Syndrome.1
Acquired Immunodeficiency Syndrome represents the late clinical stage of Infection with Human Immunodeficiency Virus
(HIV).2 Approximately 33.2 million3 people were living with HIV 2007 globally and about 5.206 million persons infected
with HIV in India.4,5 Studies suggest that life expectancy have been reduced by as much as 15 years when compared with
projections without HIV. With a high case fatality rate, significant impact on health and society, lack of definite curative
treatment or vaccine, HIV/AIDS pandemic is one of the most serious health problems of this century. Once infected, the
rate of progression of disease depends upon viral characteristics on one hand and host factors on the other and may take
from 1 year to more than 15 years to progress.6 In many patients, mucocutaneous diseases are amongst one of the first
recognized clinical manifestations of HIV/AIDS. Over the past decade it has become increasingly clear that the cutaneous
disorders are associated not only with terminal stages of immunodeficiency but also occur throughout the course of HIV

www.iaset.us editor@iaset.us
6 Revathi T. N., Mallikajuna M & Sandya

infection. Dermatological disease appears to occur more frequently as the degree of immunodeficiency worsens, disrupting
the normal physical barriers of the skin as well.1 Disorders like Kaposi’s Sarcoma, OHL, Molluscum Contagiosum on face
in adults, multidermatomal Herpes zoster, etc are one of the few indicators when patient should go for HIV sero testing.
Many serious or life threatening illnesses may be seen initially with cutaneous findings.1Widespread introduction of
HAART in mid 1990s has altered the presentation of cutaneous manifestations associated with HIV infection. This
combination therapy reduces peripheral viral load, elevate CD4 cell count. Will immune reconstitution some disease
disappeared, at the same time new diseases seen rearing their heads and few remained constant despite on HAART.
The risks associated with HAART should always be weighed against benefits. The present study aims to evaluate the use
of HAART on the prevalence and spectrum of cutaneous manifestation in HIV infected patients and to know the pattern
of decline is similar for AIDS events of different etiologies (viral, bacterial, fungal or other) and also correlate the adverse
cutaneous effects associated with HAART.

METHODOLOGY

Sample Size: 100 members, out of which 50 are on HAART and remaining 50 members not on HAART.

Method of the Study: The study was conducted at the Dermatology and STD Department of Victoria Hospital,
Bowring & Lady Curzon Hospital allied to the BMCRI, Bangalore. The study group includes 50 HIV positive patients who
presented with mucocutaneous manifestation and are not on HAART. Another 50 HIV positive patients, who are on
HAART (combination used in our set up was Stavudine, Lamivudine and Nevirapine) presenting with some
mucocutaneous manifestation were procured from Antiretroviral centre of our hospital and were involved in the study after
confirming the below mentioned criteria.

Inclusion Criteria

• Age between 16 years to 60 years.

• Patients serologically confirmed as HIV positive and who are on HAART.

• Patients serologically HIV positive and not on HAART.

Exclusion Criteria

• Patients with other immunosuppressive disorders like diabetes mellitus, malignancy and immunosuppressive
treatment.

• Age less than 16years and greater than 60years.

Procedure

Before enrolling the patient for the study, an informed consent was taken. Data was collected based on the
proforma, which includes demographic profile and clinical findings. Clinical examination was carried out in detail, in
natural light and was recorded. It included the examination of any lesion on the skin and mucous membrane from head to
toe at the time of presentation. Examination of the genital areas and skin appendages was also carried out and recorded.

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

Prevalence of Dermatological Complication among HIV Infected on HAART Patients –Across Sectional Study 7

Investigations

• HIV status was confirmed by ELISA method at VCTC centre of our hospital.

• Base line investigation like Hb%, TC, DC and ESR.

• CD4+ count.

• Potassium hydroxide (KOH) preparation to confirm dermatophytosis.

• VDRL test was done to confirm infection.

The collected data was analyzed by using SAS-16.50 version, Univariate analysis was employed to test the
significance.

RESULTS

Present study comprised of 100 HIV patients, who attended the dermatology and STD department.
The observations are as under.

Table 1: Socio-Demographic-Variables
Socio-Demographic
Number of Patients %
Variables
Age in years
16-25 09 9.0
26-35 48 48.0
36-45 30 30.0
46-55 11 11.0
>56 02 2.0
Gender
Male 55 55.0
Female 45 45.0
Marital Status
Unmarried 11 11.0
Married 89 89.0
Education
Illiterate 37 37.0
Primary 25 25.0
SSLC 31 31.0
PUC 03 3.0
Graduate 04 4.0
Occupation
Industrial worker 12 12.0
Manual worker 26 26.0
Clerical 05 5.0
Driver 11 11.0
House wife 25 25.0
Agriculture 07 7.0
Unemployed 04 4.0
CSW 03 3.0
Others 07 7.0
Income
group/month
<1500 26 26.0
1500-3500 45 45.0

www.iaset.us editor@iaset.us
8 Revathi T. N., Mallikajuna M & Sandya

Table 1: Contd.,
3501-6500 25 25.0
>6500 04 4.0
Total 100 100.0

Maximum patients belonged to age group of 26-35 years (48%) followed by the age group of 36 to 45 years
(30%). Male to female ratio is almost equal (1.2:1) Out of 100, 89 were married and 11 were unmarried. Above diagram
shows that 62% patients were having primary level or below primary level education. Majority of the patients are manual
workers which includes coolies 26%, drivers (11%) and CSW (3%). Others include shop owners, hotel waiters, vendors,
etc.71% of patients were having income below Rs. 3500/- month.

Table 2: Type of Partners and Route of Transmission

Type of Partners and Route of Number of
%
Transmission Patients
Route of Transmission
Sexual 76 76.0
Blood transfusion 04 4.0
Both BT+S 02 2.0
IDU 01 1.0
Not Elicitable 17 17.0
Type of Partner
Only regular consort 20 20.0
With CSW 53 53.0
With Friend/Acquitance/casual 03 3.0
With relatives/family friends 02 2.0

Route of Transmission

Table 2 shows the probable route of infection. In 76 patients it was only sexual route, followed by blood
transfusion in 6 patients. In 2 patients both the history was positive. Probable transmission via IDU (Intravenous drug
usage) was seen in one patient only.

Type of Partner

Out of 78 patients who gave history of sexual exposure, 53 patients in the study were exposure with CSW and 3
had sex with friend, 2 with relative. In present study 9 patients gave history of exposure to multiple partners. The
mucocutaneous manifestations are classified into infectious, non- infectious manifestation and sexually transmitted
infections in the following tables:

Table 3: Comparison of Infectious and Non-Infectious Manifestations

Group 1 Group 2
Infection Status (N=50) (N=50)
No. % No. %
Infection 41 82.0 27 54.0
Non-Infection 16 32.0 30 6.0

Incidence of overall infections are significantly less in group 2 compared to group 1 (54% vs. 82%) with
х2=9.010(1); p=0.003. Incidence of non-infectious manifestation are significantly more in group 2 compared to group 1
(60% vs. 32%) with p=0.003

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

Prevalence of Dermatological Complication among HIV Infected on HAART Patients –Across Sectional Study 9

Table 4: Prevalence of Infections

Group 1 Group 2
Infections (N=50) (N=50) P Value
No. % No. %
Bacterial 8 16.0 9 18.0 0.790
Follicultis 6 12.0 5 10.0 0.749
BT Hansen’s 0 0.0 1 2.0 1.000
Lupus Vulgaris 0 0.0 1 2.0 1.000
Chancroid 0 0.0 1 2.0 1.000
Syphilis 1 2.0 0 0.0 1.000
Gonococcal 1 2.0 1 2.0 1.000
Viral 25 50.0 15 30.0 0.041*
Herpes Zoster 9 18.0 5 10.0 0.249
Molluscum contagiosum 6 12.0 3 6.0 0.487
Herpes Genitalis 6 12.0 3 6.0 0.487
Genital Wart 4 8.0 2 4.0 0.678
Verruca Vulgaris 1 2.0 2 4.0 1.000
Fungal 12 24.0 6 12.0 0.192
Oral candidiasis 6 12.0 1 2.0 0.112
Leucorrhoea 3 6.0 1 2.0 0.617
Dermatophyte 3 6.0 3 6.0 1.000
*, Significant at 0.05 level

Above table shows among all infections, incidence of viral infections are significantly less in group 2 compared to
group 1 (30% vs 50%) patients with p=0.041.Fungal infections are more associated with group 1(24%) than group 2 (12%)
with p=0.192.

DISCUSSIONS

Present study of 100 HIV reactive patients’ reveals that in this group of population factors like low education
status, customs, illiteracy and low status of female in society, habits like alcoholism etc play important role in
manifestation and prevalence of HIV infections. General awareness about the STIs including HIV/AIDS, condom usage,
maintaining hygiene and tendency to seek quality STI health care is generally lacking, especially in women, exposing the
whole group to all the more risk of infections. Maximum number of patients belonged to the young age group 26-45 years
(78%), similar was found by Nair SP et50 al where 77.67% patients belonged to the 21 to 40 years age group. Similar was
also found by Harish MR et al51, Criton S et al52, Ganesh P et al53 where maximum numbers of patients were between
similar age group. This age group is most susceptible may be because of it being sexually most active age group, and also
half of India’s population lies within this group. According to NACO7 majority of the HIV infections (87.7%) are in the
age group of 15-44 years.7 Male to female ratio in HIV reactive patients in the present study was 1.2:1. Study of Nair SP et
al31 reported M/F ratio of 2.3:1, (M=82, F=36). As with the other studies the present study also shows male preponderance.
Male patients are more prone to high risk activities which predispose them to HIV infection.

About 62% of patients in present study were having primary (25%) or below primary level (37% were illiterate)
of education. Study of Harish MR51 showed 53.2% patients having low educational qualification. 71% patients were
having a family income below or equal to Rs 3500/- month. Both lower socio-economic status and illiteracy were an
important factor associated with the prevalence of STI including AIDS. In India, illiterates and individuals with the
primary level of education and lower income groups form the major proportion of STD clinic attendees.2

www.iaset.us editor@iaset.us
10 Revathi T. N., Mallikajuna M & Sandya

In the present study, majority of the patients are manual workers which includes coolies 26%, housewives 25%,
industrial workers 12%, drivers 11%, agricultural workers 7% clerical workers 5%, CSW 3%, unemployed 4%, others
includes tailors and businessman comprising 7%. This hospital renders free service and hence, is attended by more by
people belonging to middle and low income group. Though “Drivers” fall in a high risk group, it is not exclusive; all those
occupation which involve frequent travelling to long distances for long periods, like coolies in the present study, are at high
risk. Among women, majority of the patients (25) were housewives. This again emphasizes the main route and source of
infection in females i.e., through heterosexual contact with their spouses. 78% patients gave H/O of sexual exposure.
Findings are in accordance to study Nair et al50 78.50%. 6 patients gave h/o blood transfusion out of which 4 gave h/o only
blood transfusion and did not have h/o sexual exposure and remaining 2 patients had h/o both blood transfusion and h/o
sexual exposure. Only one patient was recorded with h/o IDU. High HIV prevalence among the IDU was observed among
the national highway linking the India and Myanmar2 and in north eastern states like Manipur, neighboring the Golden
triangle6. So naturally figures of present study for IDU do not match with National study and that could be the reason that
the figures for blood transfusion as a probable route of transmission may be high. Prostitution has emerged as a STI
multiplier.2 Several studies conducted show that majority of the male patients suffering from STI give history contact with
CSW. In present study, 58 patients gave H/O sexual exposure out of their marriage, of which 53 patients gave history of
multiple exposures to CSW. Risk of exposure to STI including HIV is directly associated with the number of sexual
partners. In the present study amongst the patient having sexual route of transmission, 8 patients gave history of having
multiple partners and 50 patients gave history of sexual contact with two partners at the time of presentation. When all the
mucocutanneous are considered together, total infection comprised of 82% in group 1 and 54% in group 2, non-infection or
inflammatory disorders comprised of 30% in group 1 and 38% in group 2, adverse drug reactions comprised of 6% in
group 1 and 26% in group 2, cutaneous carcinoma 1% in group 1 and nil in group 2. Study by Calista D. Morri M, et al46
showed cutaneous infections 66% in group 1 and 53% in group 2, inflammatory disorders 25% in group 1 and 21% in
group 2, adverse drug reactions 8% in group1 and 20% in group 2, cutaneous carcinoma 1% in group 1 and 1% in group 2.
The present study showed to be significant decrease in overall infections in patients on HAART with p=0.030 when
compared to Calista D. Morri M, et al46, The group of patients who received HAART had significantly lower cutaneous
morbidity due to opportunistic infections.Significant increase in inflammatory cutaneous diseases in patients on HAART
with p=0.030, which were accounted by increase in photodermatitis. Adverse cutaneous drug reactions were significantly
higher in the group receiving HAART. The drug reactions were the most prevalent dermatological disorder (16%). Next is
Herpes Zoster and xerosis (14%), folliculitis (11%), molluscum contagiosum and Herpes simplex (9%), oral candidiasis
(7%), dermatophyte, condylomata acuminate and photodermatitis (6%), seborrhoeic dermatitis (5%), leucorrhoea (4%),
verruca vulgaris and pruritic popular eruption (3%), gonococcal infection and eosinophilic folliculitis (2%), lupus vulgaris,
chancroid, syphilis, psoriasis, Kaposi’s sarcoma constituted 1%.

We found that a lower incidence of bacterial infections compared to the above study, probably due to the fact that
treatment (e.g. Cotrimoxazole), rather than HAART accounted for reduction in the prevalence of bacterial infections.
Among viral infections, 50% were present in group 1 and 30% in group 2. Incidence of viral infections are significantly
low in HIV patients who are on HAART with P value 0.041. A diagnosis of viral infections were 60% less frequent among
49
those patients who had initiated HAART. Study by Antonella d’Arminio Monforte, et al showed 87% decline in viral
etiology after starting HAART. Fungal infections, 24% were present in group 1, 12% in group 2. A diagnosis of fungal
infections were more associated with group 1 i.e. those who are not on HAART with the p=0.192. fungal infections were

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

Prevalence of Dermatological Complication among HIV Infected on HAART Patients –Across Sectional Study 11

50% less frequent among those patients who had initiated HAART. The present study is comparable to study by Antonella
d’Arminio Monforte, et al49 where fungal infections were 54% less frequent in patients on HAART. Bacterial infections
16% were found to be in group 1 and 18% in group 2. Study by Antonella d’Arminio Monforte, et al49 showed 69%
decline in bacterial etiology in patients on HAART. The present study shows no association between two groups, due to
the poor socioeconomic status of our population. Thus, we can confer that the pattern of decline is more pronounced for
viral etiology. Herpes Zoster was observed in 18% of patients in group 1, 10% in group 2. Incidence of Herpes Zoster is
more associated with group 1 compared to group 2 with the p=0.249.

A diagnosis of Herpes Simplex was made in 12% in group 1, 6% in group 2. Herpes simplex was 50% less
frequent among patients on HAART with p-0.487. This finding is consistent with Pedro C. Queiroz Zancanaro, et al47
which proves 47% less frequent in patients on HAART. Molluscum contagiosum were observed in 12% patients in group
1 and 6% in group 2. There was 50% reduction in patients on HAART. Pedro C. Queiroz Zancanaro, et al47 study shows
increased prevalence of Zoster and MC with HAART due to immune reconstitution. Early onset (<3 months) of infectious
immunological recovery syndrome after HAART initiation may reflect the reactivation of a once quiescent infection,
explaining the higher prevalence of both. However, duration of HAART was not assessed in our study and we did not
specifically record whether the diagnosis of HSV and VZV represented primary infection or reactivated disease. Therefore
we also recognize that our data do not distinguish between the effect of immunosuppression and immune reconstitution on
disease acquisition versus reactivation. Condylomata acuminate was found in 8% in group 1 and 4% in group 2, with 50%
reduction in patients on HAART. The present study is comparable to Hengge et al34 as they also found decrease in the
incidence of Condylomata acuminate in their study recrutiee after the initiation of HAART.

Verruca vulgaris was found in 2% in group 1 and 4% in group 2. This is comparable to Hengge et al34, as they
also reported the increase in incidence in their “under HAART” category. Study by Toby Maurer, et al35 reports, the
prevalence of cutaneous warts did not change during receipt of HAART. In HIV infected individuals treated with HAART,
the incidence of opportunistic viral infections has diminished markedly, with the exception of those caused by HPV.
HPV-induced lesions are stable or have increased despite restoration of immune function with HAART. Among
bacterial infections, folliculitis was found in 12% of patients in group 1 and 10% in group 2. Folliculitis is 20% less
frequent in patients on HAART. Present study is comparable to Pedro C. Queiroz Zancanaro, et al47 and Toby Maurer, et
al35 which reports patients not receiving HAART had increased rates of folliculitis.

One case of each BT Hansen’s and lupus vulgaris were found in group 2, none found in group 1. Pierre Couppie,
Sylvie Abel et al54 describes 3 cases of leprosy occurring in patients treated with a combination of 3 antiretroviral drugs
who fulfilled the criteria for IRIS. These cases tend to have a tuberculoid clinical appearance from the outset. They are
associated with type 1 reactional states and vasculitis and ulcerous progression is possible. Our patient did not have
reaction. Leprosy should be recognized as an IRIS associated infection with possibility of atypical presentation. Because
access to HAART is increasing in countries where leprosy is endemic, the number of IRIS cases due to M. leprae will
likely increase considerably in the near future. Above study also describes Mycobacterial infectious diseases other than
leprosy can also be associated with IRIS, although rarely with skin manifestations: M avium complex infection
(2 cases with dermohypodermal nodules) and tuberculosis (1 case with dermohypodermal nodules, with necrotizing
evolution) have been reported. Joseph A. Desimone, Roger J. Pomerantz et al reports a case of recurrent leprosy, in the
tuberculoid from secondary to increased anti-M. leprae immunity in an HIV-1-infected person after initiation of HAART.

www.iaset.us editor@iaset.us
12 Revathi T. N., Mallikajuna M & Sandya

Tuberculosis is the most common opportunistic infection in HIV disease in developing countries. Cutaneous tuberculosis
however is relatively uncommon.

Oral candidiasis was found in (6) 12% in group 1 and (1)2% in group 2. It is more associated with group 1 with
P=0.112. 5 were pseudomembranous type and 2 were angular cheilitis. The present study is comparable to Pedro C.
Queiroz Zancanaro, et al47 study where they found candidiasis to be significantly less prevalent with HAART use.
Dermatophyte infections were found in equal distributions in both groups with 6% prevalence. In group 1, among 3 cases 2
were having tinea pedis, 1 having tinea cruris. In group 2, 2 cases were having tinea corporis and 1 having tinea cruris. Our
study is comparable to Toby Maurer, et al who reported, infected women who had initiated HAART were statistically less
likely to have tinea pedis. When inflammatory or non-infectious manifestations are considered, Xerosis comprised of 18%
in group 1 and 10% in group 2. Xerosis is more associated with group 1 with p=0.249. Our study is comparable to Toby
Maurer, et al35 and Hengge et al 34 reporting decreased incidence of Xerosis in HAART initiated patients. Pruritic popular
eruptions (PPE) were seen in 4% of patients in group 1 and 2% in group 2, which is not significant with p=1.000, but slight
decrease in group 2 which is comparable to Pedro C. Queiroz Zancanaro et al47 which showed reduced prevalence among
HAART users. Photodermatitis was found only in group 2. It is significantly associated with group 2 with p=0.012. Our
study is comparable to Pedro C. Queiroz Zancanaro, et al reporting higher prevalence in patients on HAART.

The prevalence of drug reactions in group 1 was 3% and 13% in group 2. The prevalence of drug reactions was
significantly higher in patients who were receiving HAART with P=0.012. among 13 patients in group 2, 9 cases were due
to Nevirapine induced reaction, 4 due to antibiotics. Our study is comparable to Pedro C. Queiroz Zancanaro, et al showing
similar results. Incidence of seborrhoeic dermatitis was found to be 2% in group 1 and 8% in group 2. The prevalence
was found to be high in group 2. Similar results were found in Pedro C. Queiroz Zancanaro, et al study. One case of
psoriasis was found in group 1 patients. The patient was admitted with the diagnosis of extensive psoriasis, h/o sexual
exposure was present. ELISA was done and reported as HIV reactive. The appearance of psoriasis in an individual at risk
for HIV disease may be an indication for HIV sero testing. Psoriasis with onset after HIV infection has been observed to
improve more with HAART than psoriasis that was present before HIV infection. Munoz-Perez MA et al55 study has noted
that the severity of seborrhoeic dermatitis and psoriasis changed after initiation of HAART despite no change in
prevalence.

Only one case of kaposi’s sarcoma found in group 1 and none in group 2. Reports show reduced prevalence of
kaposi’s sarcoma among HAART users. Kharkar V et al56 reports, Kaposi’s sarcoma affecting skin and mucous membrane
has been rarely reported and only nine such cases exist in the published literature from India. Two - cases of eosinophilic
folliculitis were found in group 2 i.e., in patients who are on HAART. Of which 1 is biopsy proven. Study by Priya M.
Rajendran et al57 is the first to document EF as part of ART-associated immune reconstitution.

When STIs are separately considered, 28% found in group 1, 14% in group 2. Prevalence of STI is significantly
low in group 2 compared to group 1 with p=0.086, this may be due to strict abstinence from illicit sexual activity after
being diagnosed as HIV positive. Among STIs, Herpes genitalis constituted the major numbers (8%), followed by
condylomata acuminate (6%), leucorrhoea (4%), genital molluscum and gonorrhea (2%), chancroid and syphilis (1%).

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

Prevalence of Dermatological Complication among HIV Infected on HAART Patients –Across Sectional Study 13

CONCLUSIONS

The incidence of most of mucocutaneous manifestations decreased after starting HAART, the pattern of decline
was more pronounced for events with a viral etiology and for STIs.Cutaneous adverse reactions from antiretroviral agents
have become increasingly important to recognize as population of patients surviving with HIV infection grows.
Dermatologists play an important role in managing these cutaneous effects of HAART therapy in HIV patients. HAART
has decreased the prevalence of certain skin diseases. The decreases in the prevalence of skin disease can be important
motivator among persons receiving HAART with regard to therapy adherence. As the treatments for HIV continues to
advance, it is likely that the cutaneous manifestation will also continue to evolve and further studies will be required to
adequately assesses their changing nature and prevalence.

LIMITATIONS OF THE STUDY

Present study did not take duration of HAART therapy into account, because of the variability of treatment
duration between study visits. The duration of HAART therapy may influence the prevalence of dermatologic disease. We
did not specifically record whether the diagnosis of certain condition represented primary infection or reactivated disease.

ACKNOWLEDGEMENTS

The Author Acknowledges The Dean Cum Director and Professor and HOD, Department of Dermatology,
BMCRI, Bangalore-560002.

REFERENCES

1. Theodore Rosen & Jeanne Howell Spedale. Relationships between Sexually Transmitted Diseases and HIV
Infection. In Current Problems in Dermatology, P. Scott Harris & Michael S. Saag, Published at California:
Mosby Publishers, 1997: Volume 9 No.6, Pg 217-258.

2. V.K. Sharma. Sexually Transmitted Disease and AIDS: Printed at New Delhi: Viva Publishers: Ist edition; 2003:
Pg 5-7, 13, 53, 55, 62, 65, 68, 81, 88-93.

3. http://www.amfar.org/cgi-bin/iowa/abouthiv/record.html?record=3

4. http://news.bbc.co.uk/1/hi/health/5030184.stm.

5. http:// india. gov.in/sectors/health_family/national_aids.php

6. Marcussen DC, Sooy CD, San Francisco. Otolaryngologic and Head and Neck manifestations of AIDS.
Laryngoscope 1985; 95: 401-5.

7. Bhushan Kumar & Somesh Gupta. Sexually Transmitted Infections: Printed in India, Elsevier Publishers, 2006:
Pg 63-66. 673-693, 785-709.

8. http://www.nacoonline.org/facts_overview.htm.

9. Tony Burns, Stephen Breathnach, Neil Cox, Cristopher Griffiths. Rook’s text book of Dermatology. 7th ed.
Blackwell publishing: pg 26.11, pg 16.12.

10. www.aidsetc.org.

www.iaset.us editor@iaset.us
14 Revathi T. N., Mallikajuna M & Sandya

11. Valia RG, Ameet R Valia & K Sidappa. IADVL Text Book of Dermatology. Printed in Mumbai, 2nd ed, Bhalani
Publishing House; 2003: Pg 1501-1532.

12. Coldirin BM et al. Prevalence and clinical spectrum of the skin disease in patients infected with HIV. Arch
Dermatol 1989; 125:357-61.

13. “HIV/AIDS clinical care, Train the trainer programme for doctors”. March 2006, India PP 25-28.

14. K.Triapathi M.D. “Essentials of Medical Pharmacology” 5th edition. Jaypee Brothers Medical Publishers (P) Ltd.
New Delhi. PP:730.

15. APF guidelines for HIV/AIDS 2007.

16. Warren KJ et al. Nevirapine associated Steven-Johnson syndrome Lancet 1997; 351:567.

17. Rey D, et al. Prednisolone does not prevent occurrence of Nevirapine induced rashes. AIDS 1999; 13:2307.

18. Demoley et al. Nevirapine – induced cutaneous hypersensitivity reactions and successful tolerance induction. J
Allergy Clin Immunol 1999; 104: 504-5.

19. Metry DW, et al. Steven – Johnson syndrome caused by antiretroviral drug Nevirapine. J Am Acad Dermatol
2001; 44(2 suppl): 354-7.

20. Dodi F, et al. Steven-Johnson syndrome in HIV patients treated with nevirapine, two case reports. AIDS 2002; 16;
197-8.

21. Erwin K Kastrup (ed) Drug facts and comparison 2000. 54th edition. Steven K. Hebel RPh: 1424-1465.

22. Adkin S JC and noble S. Efavirenz. Drugs 1998; 1055-1064.

23. Anthony S. Fauci H, Dennis L. Kaspel (ed), et al. Harrison’s Principles of internal medicine. Vol. II 16th edition,
Mc Graw Hill Medical Publishing division PP: 1124-1134.

24. Bouscarat F, et al. ‘Paronychia and Pyogenic granuloma of the great toes in patients treated with Indinavir’. N
Engl J Med 1998; 338: 1776-1777.

25. Newell A, et al. Photosensitivity reaction of Efavirenz. Sex Transm Infect 2000; 76:221.

26. Treudler R et al. Efavirenz induced photoallergic dermatitis in HIV: AIDS 2001; 15: 1085-6.

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0