title: Nail changes in patients infected with human immunodeficiency virus. A prospective controlled study.
abstract: OBJECTIVE
  To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)-infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects.
  
  
  METHODS
  Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed.
  
  
  METHODS
  Primary care university hospital.
  
  
  METHODS
  A total of 155 HIV-1-positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio.
  
  
  METHODS
  None.
  
  
  METHODS
  Clinical examination findings.
  
  
  RESULTS
  Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P << .001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P < .05), transverse lines (7.1%) (P < .01), onychoschizia (7.1%) (P < .05), leukonychia (14.3%) (P < .001), and longitudinal melanonychia (14.8%) (P < .01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P < .001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients.
  
  
  CONCLUSIONS
  Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.
authors.affiliation: Dermatology Department, University Hospital, Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Cribier
authors.forename: M L
authors.initials: ML
authors.lastname: Mena
authors.forename: D
authors.initials: D
authors.lastname: Rey
authors.forename: M
authors.initials: M
authors.lastname: Partisani
authors.forename: V
authors.initials: V
authors.lastname: Fabien
authors.forename: J M
authors.initials: JM
authors.lastname: Lang
authors.forename: E
authors.initials: E
authors.lastname: Grosshans
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies