Mucocutaneous disorders among HIV/AIDS adult patients with anti-retroviral treatment failure attending Amtulabhai Karimjee Care and Treatment clinic in Dar es salaam

Abstract

ABSTRACT Background: Majority of HIV infected individuals present with one or more cutaneous disorders during the course of their HIV infection and may present at treatment failure. Treatment failure in developing countries is on the rise; however, scanty literature exists on mucocutaneous disorders in patients with ART failure. Objective: To determine the pattern of mucocutaneous disorders among HIV/AIDS patients with treatment failure attending Amtulabhai Karimjee Treatment failure Clinic (AKC) in Dar es Salaam. Study design and settings: A clinic – based descriptive cross sectional study was conducted among HIV patients with ARV treatment failure attending Amtulabhai Karimjee Treatment failure Clinic. Materials and Methods: All patients referred to AKC were scrutinized to ascertain their ARV treatment failure status. Patients with treatment failure were then consecutively recruited into the study after obtaining their written consent to achieve the required sample size. Appropriate clinical information obtained through history and complete dermatological examination was recorded into a specially designed questionnaire. Blood sample was taken for the determination of CD4+ T-Lymphocytes count by Flowcytometry. Dermatological diagnoses were made based on observed clinical features and in doubtful cases assistance was sought from a Dermatologist. Investigations including skin biopsies were taken where indicated. Digital photographs were taken where necessary for discussion with a Dermatologist. Data was analyzed using SPSS, and Chi squared test was used to compare proportions. Results: Two hundred and forty six subjects were enrolled into the study, of whom 154 (62.6%) were females. The overall mean age was 40.5 (SD±10.5) years. The age ranged from 19 to 73 years. The overall prevalence of one or more mucocutaneous disorder was 52.8%. vii There was a striking female preponderance of patients with mucocutaneous disorders 94/130 (72.3%). The elderly (>47 years) were the least affected 27/66 (40.9%) compared to the age groups (19 – 32 years) who were most affected 32/51(62.7%. Inflammatory/ papulosquamous disorders ranked highest, with an overall prevalence of 79/130 (60.8%). Pruritic Papular Eruption (PPE) was the commonest of these, having a prevalence of 71/130 (54.6%). Females had three times the prevalence of PPE compared to males. Seborrhoeic dermatitis and Eczema were each prevalent in 3/130 (2.3%) of patients. Lichenoid hypersensitivity reaction and lichen simplex chronicus were the least common. Infectious diseases had a prevalence of 64/130 (49.2%). Of these, fungal infections were most predominant being present in 31/130 (23.8%) of patients. Viral infections had a prevalence of 30/130 (23.0%). Malignant conditions were rare, being encountered in 3 patients only; 2 with sarcoma, and 1 with squamous cell carcinoma, Among the 130 patients, 80.8% had one type of mucocutaneous disorder; while 19.2% had 2 or more types mucocutaneous disorders. Of those patients with CD4 count less than 200 cells/µl, PPE was encountered more frequently 60/120 (50%) compared to other mucocutaneous disorders, p=0.003. The mean CD4 count of patients with PPE was 166.1 cells/µl. Conclusion: – Majority of patients with treatment failure were females – Mucocutaneous disorders were a common presentation in patients on treatment failure – Chronic persistent PPE was the most frequent mucocutaneous disorder finding – More then two third of the mucocutaneous disorders presented at the CD4 T cell counts less than 200 cells/µl Recommendation In view of the high frequency of mucocutaneous disorders in patients with treatment failure, Clinicians should be sensitized to perform a thorough dermatological examination in each patient. Presence of PPE should increase the index of suspicion for ARV failure