Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

574 Abstracts 32268-32274

12th World AIDS Conference

S32268 Erythema of the proximal nailfold in HIV-infected patients:
Frequency, relation to hepatitis C virus and HIV-viral load
Peter H. Itin1, S. Courvoisier', M. Battegay2. 1Dept of Dematology University
Basel, Petersbraben 4, 4031 Basel; 2University Hospital of Basel, Switzerland
Background: Periungual erythema was first described as a marker of HIV-infection in 1995 (Itin et al). It is still unclear how often periungual erythema occur and
how often it is associated with hepatitis C virus (HCV) infection and a high HIV
viral load.
Objectives: To define the frequency of periungual erythema and to elucidate
the association of periungual erythema with HCV infection and HIV activity.
Methods: 540 HIV-infected patients who were followed between January 1992
and June, 30th 1997 at the Basel HIV-clinic were analyzed. Patients were systematically examined for dermatological affections by an experienced dermatologist
and data was collected prospectively.
Results: Between January 1992 and June, 30th 1997 we documented periungual erythema in 22 (4.1%) out of 540 HIV-infected patients. Confirmed positive
HCV-serology was documented in 12 patients, negative values in five. In one
patient the confirmation test for HCV was questionable (however, this patient had
cryoglobulins, known to be associated with HCV). In two patients no evidence
of HCV was found and in two patients HCV serology was not performed. Liver
enzymes were elevated in 7 patients. There was no patient with positive hepatitis
B antigen. The HIV vital loads at the time of diagnosis found in these patients
showed a broad range (between below detection limit and 750,000 copies/ml,
median 24,000).
Conclusion: Periungual erythema in HIV-infected patients is most often associated with HCV-infection regardless of liver enzyme elevation. The broad range
of HIV vital load indicates that periungual erythema can be present with any HIV
activity.
32269 1 Acyclovir-resistant herpes zoster in 18 HIV-infected
patients: Results of treatment with foscarnet
Guillaume Breton, C.E. Caumes Eric, F.A.M. Fillet Anne-Marie, L.C. Lecomte
Claire, K.C. Katlama Christine, B.F. Bricaire Francois. Service De Maladies
Inffectueuses, Hospital Pitie-Salpetriere, Paris, France
Objective: To report the epidemiological and clinical features of acyclovir-resistant
herpes zoster and to evaluate the efficacy of foscarnet.
Design and Methods: Retrospective study of all consecutive cases of acyclovir-resistant herpes zoster. Herpes zoster was confirmed by isolation of VZV in
culture. Acyclovir resistance was defined as a failure to heal despite intravenous
(30 mg/kg/day) or oral (4 g.day) acyclovir treatment. Patients were treated with
foscarnet (200 mg/kg/day).
Results: Eighteen patients were included; 14 had AIDS. The mean CD4+ cell
count was 20 x 106/L. The mean number of previous zoster episodes was 1.53
in the 15 patients with a history of zoster. Fifteen of the 16 patients evaluable for
previous acyclovir treatment had received the drug. Skin lesions were crusted or
verrucous papules in 17 cases (94%) and occurred a mean of 8.7 weeks (2-24
weeks) previously. Thirteen patients were treated with intravenous foscarnet (200
mg/kg/day) for a mean of 17.8 days (range, 12 to 30 days). Complete healing was
observed in 10 (77%) of the 13 treated patients. The treatment was well tolerated,
except by one patient. Zoster relapsed after foscarnet cessation in 5 (50%) of the
10 responding patients. The median time to relapse was 110 days (range, 30 to
360 days). Of the 16 patients available for long-term follow-up, 4 (25%) died of
VZV-associated visceral complications after a mean of 9.8 months, and 10 died
of other infections after a mean of 5.4 months.
The onset of acyclovir-resistant herpes zoster is associated with severe immunodepression, reccurences of zoster and previous acyclovir treatment. Such
infection has poor long term pragnosis but respond well to foscarnet at a daily
dose of 200 mg/kg.
132270 MMucocutaneous problems in HIV-infected patients:
A prospective cohort study
Peter H. Itin1, Nathalie Schaub1, S. Courvoisier1, L. Sponagel2, N. Gyr2,
T.H. Rufli', M. Battegay2. 'Dept of Dermatology, University Basel, Petersgraben
4, 4031 Basel; 2University of Hospital of Basel, 4031 Basel, Switzerland
Objectives: To determine the incidence of mucocutaneous problems in HIVinfected patients, the impact of risk groups and changing trends within the last
years.
Methods: Within 71 months we included prospectively 576 patients with proven
HIV infection in our cohort study.
Results: Our cohort included 161 women (27.9%) and 415 men. 172 patients
(29.9%) belonged to the risk group of homosexuality, 35 (6.1%) were bisexual,
119 (20.7%) heterosexual and 217 (37.7%) were i.v. drug users. Patient age at
the first reactive HIV-test ranged between 15 and 68 years (mean 30). HIV-related
skin problems such as candida-stomatitis developed in 238 (41.3%) patients and
Kaposi's sarcoma in 35 men (8.4% of men). The most common HIV associated

dermatological problems were dry skin (267, 46.4%), tinea (239, 41.5%), seborrheic dermatitis (197, 34.2%), verrucae vulgares (160, 27.8%), folliculitis (134,
23.3%) and herpes simplex (80, 13.9%). 63 (10.9%) patients had condyloma
acuminata, 62 (10.8%) mollusca contagiosa and 25 (4.3%) showed bacterial
infections. 83 (14.4%) patients had a reactive syphilis serology.
Conclusion: Our data demonstrate that the most common skin problems are
of infectious origin. Seborrheic dermatitis which may be related to Malassezia

furfur develops early in the disease process but had no impact on the prognosis.
In contrast mollusca contagiosa and Kaposi's sarcoma indicate markedly reduced
CD4 cell count. Our demographics show that the incidence of mucocutaneous
problems have not changed dramatically within the last three years.
|32271 Skin manifestations in patients under the combination
therapy (CT)
Marcio Serra. R. Alberto De Campos/Conselho Regional de Medicina-RJ-Cam.
Technica de AIDS, Rio de Janeiro, RJ, Brazil
Issues: Analyze the impact of the CT with protease inhibitor (PI) on the skin.
Project: Skin examination and follow up of adult patients that started CT with
any PI from July '96 until December '97.
Results: A total of 220 patients were examined, oral candidiasis cleared up
in all patients with no relapses. Kaposi sarcoma start to improve after 2 months
of CT. There was an improvement of psoriasis and molluscum conyagiosum
(MC) lesions. Although MC relapsed in some patients, lesions were smaller and
recurence less frequent. Most part of the patients presented side efffects on
skin because of the teraphy, and the principals were: dryness of lips and skin;
eczema; asteatosis; lipodistrophy; scalp and body hair loss (specially legs, axils
and pubis). Re-activation of HIV related-prurigo, herpes simplex and zoster, and
inflamatory disorders were noticed in some patients.
Although CT brought a better quality of life to AIDS patients, it modificates skin
conditions what needs a close attention by patients and health care workers.
S32272 | Skin manifestations as predictors of HIV infection in
Malawi
Dickman Zimba', I. Hoffman2, R. Royce2, P.N. Kazembe', R. Chakroborty2,
C.C. Daly3, M.S. Cohen2. 'Lilongwe Central Hospital PO Box 149 Lilongwe;
3JSI Stafh Project Lilongwe, Malawi; 2University of North Corolina Chapel Hill
NC, USA
Objective: To determine the dermatological conditions among an out-patient
population that predict HIV infection.
Methods: Male out-patients presenting to a dermatological clinic in Lilongwe,
Malawi were enrolled and a questionnaire administered. HIV serostatus was determined by repeat ELISA. Dermatological impression and diagnosis was made
clinically by a single clinician.
Results: One hundered and twenty-three (123) patients with dermatological
conditions were enrolled. 60% were HIV- positive. HIV serostatus did not differ
by age, education or body mass index (10,000 x wt/ht2). Conditions with positive
predictive values (PPV) for HIV infection greater than.80 were herpes zoster (N
= 5, PPV = 1.0) seborrhoea (N = 17, PPV =.82) and psoriasis N = 5, PPV =.80).
Patients presenting with pityriasis rosea (N = 31) were rarely infected with HIV
(PPV =.13).
In dermatological out patient clinics in Malawi, herpes zoster, seborrhoea and
psoriasis are highly predictive of HIV infection. Pityriasis rosea appears to be
predictive of HIV seronegativity. Algorithms for HIV screening and management
could be developed for dermatological patients presenting with the conditions
highly predictive of HIV infection.
32273 1 Cutaneous disorders in HIV-infected children
Luminita-Monica Luminos, M. Mardarescu, S. Petrea, I. Darasteanu. Colentina
Hospital, Bucharest, Romania
We have studied the cutaneous manifestations in 60 children out of 220 children
infected with HIV admitted in our clinic during 1996. The majority of children
infected with HIV developed some form of skin disease during the course of their
illness. For 26 of them a mucocutaneous disorder was the presenting sign of HIVrelated disease. In other cases, skin disease was a manifestation of an important
opportunistic infection or was evidence of deterioration in immune status.
The most affected age group was 8-9 years (32 cases) followed by age groups:
6-7 years (18 cases), 4-5 years (6 cases) and infants (4 cases).
The most frequent skin disorders that were noted as a unique cutaneous manifestation or mixed we have met were as follows: bacterial infections (36), fungal
infections (17), viral infections, Kaposi's sarcoma (2), inflammatory disorders (26).
Conclusions: We appreciate that information of this sort will help the paediatric clinician to observe early warning signs of HIV-infection and institute the
procedure of detection of illness and antiretroviral therapy when indicated.
|32274 Mucocutaneous manifestations associated with HIV
infection in Romania
Elisabeta Otilia Benea, V. Benea. Sos. Mihai bravu 116 BI. D5, Ap. 30 Sector 2
Bucharest, Romania
Objectives: To evaluate the incidence and characteristics of mucocutaneous

manifestations of HIV infection in Romania.
Methods: The study was performed among 100 patients. They were clinically
examinated; mycological examination was necessary in 57 cases and skin biopsy
in 7 cases.
Results: The age of patients ranged from 6 months to 62 years. The children
represented 54% of cases. Mucocutaneous manifestations were observed in 76%
of patients. The majority of these were infections: oropharyngeal candidiasis-37