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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3181c15da4
Original Studies

Skin Disease Among Human Immunodeficiency Virus-Infected Adolescents in Zimbabwe: A Strong Indicator of Underlying HIV Infection

Lowe, Sara MRCP*†; Ferrand, Rashida A. MSc, MRCP*‡§; Morris-Jones, Rachael PhD, FRCP¶; Salisbury, Jon FRCPath∥; Mangeya, Nicholas MB ChB*‡; Dimairo, Munyaradzi MSc‡; Miller, Robert F. FRCP§**; Corbett, Elizabeth L. PhD, MRCP‡§

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Abstract

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/μL (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.

© 2010 Lippincott Williams & Wilkins, Inc.

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