The prevalence and pattern of skin diseases in relation to CD4 counts among HIV-infected police officers in Dar es Salaam.
Among HIV-infected individuals, skin diseases cause significant morbidity and are frequently the initial indication of immunosuppression. From an on-going cohort study to determine prevalence and incidence of HIV infection among police officers (POs) and their suitability for HIV vaccine trials, a sub-study was carried out to determine the prevalence and pattern of skin diseases among HIV-infected POs and relate this to their immunodeficiency status. Consenting HIV-infected POs and their age and sex-matched HIV-negative officers were assessed for presence and type of skin diseases at their workplaces. A questionnaire was used for data collection. Immunodeficiency was measured by plasma CD4+ lymphocytes using flow cytometry. Between November 1998 and 31 December 2000, 716 POs were assessed. Overall HIV-1 prevalence was 17.7% (127/716). One hundred and ninety-one POs (26.7%) had at least one skin diagnosis. HIV-infected POs had significantly higher (41.7%) prevalence of skin diseases than HIV-uninfected POs (26.4%), P = 0.002. Fungal infections were common in both HIV-infected and uninfected POs. Among the HIV infected, other common diseases were: herpes zoster (11.8%); pruritic papular eruption (PPE) (7.1%); seborrheic dermatitis (5.5%); and Kaposi's sarcoma (KS) (1.6%). KS and PPE were associated with severe immunodeficiency, with mean absolute (percentage) CD4+ counts of 75.5 cells/microL (4.0%) and 71.7 cells/microL (4.8%), respectively. The values for herpes zoster and seborrheic dermatitis were 271.1 cells/micronL (12.4%) and 206.3 cells/microL (11.3%), respectively. Skin diseases were common among HIV-infected POs. PPE and KS are markers of severe immunodeficiency due to HIV. PPE, herpes zoster and KS strongly suggest underlying HIV-related immunodeficiency and patients with these conditions should be counselled and tested for HIV.
Muhammad
Bakari
B
Muhimbili University College of Health Sciences, PO Box 65001, Dar es Salaam, Tanzania. mbakari@muchs.ac.tz
Eligius
Lyamuya
L
Mugusi
Ferdinand
F
Aris
Eric
E
Chale
Stella
S
Magao
Paul
P
Josiah
Robert
R
Moshi
Adeline
A
Swai
Andrew
A
Pallangyo
Ndetiyo
N
Sandstrom
Eric
E
Mhalu
Fred
F
Biberfeld
Gunnel
G
Pallangyo
Kisali
K
D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005434:Flow Cytometry; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009790:Occupations; D015995:Prevalence; D012871:Skin Diseases / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000473:pathology; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology