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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‡§

The Pediatric Infectious Disease Journal: April 2010 - Volume 29 - Issue 4 - p 346-351
doi: 10.1097/INF.0b013e3181c15da4
Original Studies

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.


From the *Department of Medicine, University of Zimbabwe, Harare, Zimbabwe; †The Garden Clinic Sexual Health Service, Upton Hospital, Slough, United Kingdom; ‡Biomedical Research and Training Institute, Harare, Zimbabwe; §Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Departments of ¶Department of Dermatology, Kings College Hospital, London, UK; and ∥Histopathology, Kings College Hospital, London, United Kingdom; and **Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom.

Accepted for publication September 15, 2009.

The authors have no conflicts of interest.

Address for correspondence: Sara Lowe, MRCP, The Garden Clinic, Upton Hospital, Berkshire East Primary Care NHS, Trust, Slough SL1 2BJ, United Kingdom. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.