Department of Medicine, University of Zimbabwe, Harare, Zimbabwe.
Pediatr Infect Dis J. 2010 Apr;29(4):346-51. doi: 10.1097/INF.0b013e3181c15da4.
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.
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.
: 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).
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.
南部非洲正在出现一种长期存活的垂直获得性人类免疫缺陷病毒（HIV）感染的流行，这些青少年在未接受治疗的情况下感染 HIV。在这个年龄段，尚未描述过在 HIV 感染者和儿童中常见的皮肤病。我们调查了津巴布韦两家中央哈拉雷医院收治的青少年中皮肤病的患病率和类型。
连续纳入 301 名入住 2 家中央哈拉雷医院的青少年，进行皮肤科检查。采集临床病史、HIV 血清学和 CD4 淋巴细胞计数。单纯疱疹病毒 2 型血清学被用作性行为的替代标志物。
共有 139 名（46%）患者 HIV-1 抗体阳性，其中只有 2 名（1.4%）单纯疱疹病毒 2 型抗体阳性。HIV 感染者和未感染者的任何皮肤疾病患病率分别为 88%和 14%（比值比：37.7，95%置信区间：19.4-72）。最常见的 HIV 相关疾病是瘙痒性丘疹性皮疹（42%）和>5%体表面积的扁平疣（24%）。有 3 种或更多种皮肤疾病、反复出现皮疹和口角炎的病史，与 CD4 计数<200 个细胞/μL 均相关（P<0.03、P<0.01 和 P<0.05）。
在津巴布韦住院的 HIV 感染青少年中，皮肤疾病是潜在 HIV 感染的常见且显著特征。在资源匮乏的地区，随着艾滋病流行的成熟，皮肤疾病的存在应被视为 HIV 检测的强烈指征，特别是因为它可能反映出免疫抑制严重。以前未描述过多发性扁平疣的高频率，这可能是垂直感染与水平感染青少年之间的区别特征。
