Skin disease among human immunodeficiency virus-infected adolescents in Zimbabwe: a strong indicator of underlying HIV infection.
BACKGROUND
Southern Africa is witnessing the emergence of an epidemic of long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection presenting with untreated HIV as adolescents. Dermatologic conditions, common in both HIV-infected adults and children, have not been described in this age-group. We investigated the prevalence and spectrum of skin conditions in adolescents admitted to hospitals in Zimbabwe.


METHODS
A total of 301 consecutive adolescents admitted to 2 central Harare hospitals, underwent a dermatologic examination. Clinical history, HIV serology, and CD4 lymphocyte counts were obtained. Herpes simplex virus-2 serology was used as a surrogate marker for sexual activity.


RESULTS
: A total of 139 (46%) patients were HIV-1 antibody positive, of whom only 2 (1.4%) were herpes simplex virus-2 antibody positive. The prevalence of any skin complaint among HIV-infected and uninfected participants was 88% and 14%, respectively (odds ratio: 37.7, 95% confidence interval: 19.4-72). The most common HIV-related conditions were pruritic papular eruptions (42%) and plane warts >5% of body area (24%). Having 3 or more skin conditions, a history of recurrent skin rashes and angular cheilitis were each associated with CD4 counts <200 cells/microL (P < 0.03, P < 0.01, and P < 0.05, respectively).


CONCLUSIONS
Skin disease was a common and striking feature of underlying HIV-infection in hospitalized HIV-infected adolescents in Zimbabwe. In resource-poor settings with maturing epidemics, the presence of skin disease should be regarded as a strong indication for HIV testing and especially as it may reflect advanced immunosuppression. The high frequency of multiple plane warts has not previously been described, and may be a feature that distinguishes vertically-infected from horizontally-infected adolescents.
Lowe
Sara
S
Department of Medicine, University of Zimbabwe, Harare, Zimbabwe. saralowe@fastmail.fm
Ferrand
Rashida A
RA
Morris-Jones
Rachael
R
Salisbury
Jon
J
Mangeya
Nicholas
N
Dimairo
Munyaradzi
M
Miller
Robert F
RF
Corbett
Elizabeth L
EL
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D000293:Adolescent; D002648:Child; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012871:Skin Diseases / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D011795:Surveys and Questionnaires; D014860:Warts / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D015030:Zimbabwe / Q000453:epidemiology