Dermatological manifestations in PLHIV visiting link ART centre at rural medical college hospital in Western Tamilnadu, India

Mohankumar Vedhanayagam, Rajesh Rajagopalan, Srinivasahan Karatupalyam Govindan, Balamurgan Bhavani Rajendran


Background: Ever since the early reports of human immuno deficiency infection, it presented as wide range of infectious and non-infectious dermatoses which correlate with the degree of immunodeficiency. Skin assessment remains a vital tool in the diagnosis and management of HIV infection due to relative easiness of examination. Most of skin diseases are amenable to diagnosis by inspection and biopsy. In this descriptive study, we have enumerated in detail the dermatological manifestations of Link ART centre clients.

Methods: To analyze the dermatological manifestations in people living with HIV, we undertook a prospective observational study of all PLHIV on ART visiting IRT Perundurai Medical College Hospital link anti- retroviral therapy centre (LAC) during July 2015 to August 2016 with focus to skin manifestations.

Results: Among the 140 clients, 22 in 2010, 12 in 2011, 6 in 2012, 51 in 2013, 36 in 2014, and 9 in 2015, 3 up to June 2016 enrolled for follow up. 31 were transferred to nearby ART, Link ART centres during this period as per their request, 4 lost for follow up and 6 deceased after enrolment, finally ninety-nine (39 male; 60 female) were utilizing our centre during the study period. Majority of participants were on ZLN (zidovudine, lamivudine, and nevirapine) regimen, hailing from rural zones, belonged to low or low middle income group, were undertaking farming, cattle rearing. CD4 counts of the asymptomatic clients in the ZLN group noted increase and decrease in the ZLE (zidovudine, lamivudine, and efavirenz), TLN (tenofovir, lamivudine, and nevirapine) group.  In the symptomatic clients, decline in the individual and the mean counts except in female ZLN subset. 70% were clinically asymptomatic and 30 % were having some dermatological manifestations. Multiple manifestations were seen in 5 clients during the study period. Dermatological manifestations observed commonly were fungal and viral infections, xerosis/ichthyoses, adverse drug reactions like lipodystrophy, and discoloration of nails.

Conclusions: Skin manifestations observed in this study were due to aging and long term cosmetic side effects of highly active antiretroviral therapy  (HAART). Lipodystrophy posed significant aesthetic distress in HAART clients. Hence, early management would decrease the most offending cosmetolgical side effects of the disease and drugs. Therapy yields the declining trend in the inflammatory, infectious dermatoses.


Human immunodeficiency virus infection, Link antiretroviral therapy centre, Mucocutaneous manifestations

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Prabhakaran N, Jaisankar TJ, Hamide A, Malathi M, Kumari R, Thappa DM. Effect of antiretroviral therapy on mucocutaneous manifestations among human immunodeficiency virus- infected patients in a tertiary care centre in South India. Indian J Sex Transm Dis. 2015;36:166-73.

Vedhanayagam M, Rajagopalan R. Prevalence of mucocutaneous manifestations in human immunodeficiency infection- learning from a rural centre in Tamilnadu, India. Int J Res Med Sci. 2016;4(6):1959-1965.

Vedhanayagam M, Sengodan S, Rajagopalan R. Occupational exposure, drug toxicities and adherence to HIV Post Exposure Prophylaxis: a cohort study at the teaching hospital in Erode district, Tamilnadu, India. Int J Adv Med. 2016;3:625-31.

Antiretroviral therapy guidelines for HIV-Infected adults and adolescents Including post-exposure prophylaxis, May 2007, NACO, Ministry of Health and Family Welfare, Government of India.

ART guidelines for HIV-Infected Adults and Adolescents: May 2013, NACO, Ministry of Health and Family Welfare, Government of India.

Cedeno-Laurent F, Gómez-Flores M, Mendez N, Ancer-Rodríguez J, Bryant JL, Gaspari AA, et al. New insights into HIV-1-primary skin disorders; J International AIDS Society. 2011.

Altman K, Vanness E, Westergaard RP. Cutaneous manifestations of human immunodeficiency virus: a clinical update. Curr Infect Dis Rep. 2015;17(3):464.

Kumarasamy N, Solomon S, Madhivanan P, Ravikumar B, Thyagarajan SP, Yesudian P. Dermatologic manifestations among human immunodeficiency virus patients in south India. Int J Dermatol. 2000;39(3):1925.

Sharma A, Chaudhary D, Modi M, Mistry D, Marfatia YS. Noninfectious cutaneous manifestations of HIV/AIDS. Indian J Sex Transm Dis. 2007;28:19-22.

Naswa S, Khambhati R, Marfatia YS. Pruritic papular eruptions as presenting illness of HIV. Indian J Sex Transm Dis. 2011;32:118-20.

Samanta M, Kundu C, Sarkar M, Bhattacharyya S, Chatterjee S. Papular pruritic eruptions: A marker of progressive HIV disease in children: Experience from eastern India. Indian J Sex Transm Dis. 2009;30:79-83.

Aydin AÖ, Karaosmanoğlu KH, Korkusuz R, Özeren M, Özcan N. Mucocutaneous manifestations and the relationship to CD4 lymphocyte counts among Turkish HIV/AIDS patients in Istanbul, Turkey. Turk J Med Sci. 2015;45(1):89-92.

Kore SD, Kanwar AJ, Vinay K, Wanchu A. Pattern of mucocutaneous manifestations in human immunodeficiency virus-positive patients in North India. Indian J Sex Transm Dis. 2013;34:19-24.

Sharma S, Puri KJPS, and Gambhir ML. Male preponderance in HIV seropositive patients with mucocutaneous complaints in a tertiary care hospital in North India. Asian Pac J Trop Biomed. 2014;4(1): S186-8.

Lokhande AJ, Sutaria A, Shah BJ, Shah AN. Changing incidence of nevirapine-induced cutaneous drug reactions: After revised guideline Nov 2011. Indian J Sex Transm Dis. 2013;34:113-8.

Marfatia YS, Talwar M, Agrawal M, Sharma A, Mehta K. Mitochondrial toxicities of nucleoside analogue reverse transcriptase inhibitors in AIDS cases. Indian J Sex Transm Dis. 2014;35:96-9.

Sharma A, Modi M, Sharma A, Marfatia YS. Cutaneous eruptions associated with nevirapine therapy in AIDS cases. Indian J Sex Transm Dis. 2007;28:94-6.

Reynaud Mendel B, Janier M, Gerbaka J, Hakim C, Rabian C, Chastang C, Morel P. Dermatologic findings in HIV1infected patients: a prospective study with emphasis on CD4+ cell count. Dermatology. 1996;192(4):3258.