Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
doi: 10.4103/0378-6323.53142
PMID: 19584470

Clinico-epidemiological profile of cutaneous manifestations among human immunodeficiency virus positive patients in the sub-Himalayan region

Sumit Sen, Saswati Halder, Sukanta Mandal, Partho Pratim Pal, Atin Halder, Parna Bhaumik
 Departments of Dermatology, Venereology and Community Medicine, North Bengal Medical College, Susrutnagar, West Bengal, India

Correspondence Address:
Sumit Sen
CG-75, Sector-2, Salt Lake, Kolkata - 700 091, West Bengal
How to cite this article:
Sen S, Halder S, Mandal S, Pal PP, Halder A, Bhaumik P. Clinico-epidemiological profile of cutaneous manifestations among human immunodeficiency virus positive patients in the sub-Himalayan region. Indian J Dermatol Venereol Leprol 2009;75:403-405
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology


Dermatological expressions often provide the first clue to an underlying HIV infection. Skin lesions in this disease are atypical and unresponsive as compared to those occurring in immunocompetent patients. [1] The purpose of this article is to highlight the cutaneous manifestations of HIV-infected patients who consulted the antiretroviral therapy (ART) center of this referral hospital in the hilly district of Darjeeling.

Three hundred and five new cases who were tested positive for HIV between September 2006 and November 2007, were examined for mucocutaneous lesions. Patients with multiple skin lesions were also tested for HIV by ELISA technique. Skin biopsy was undertaken wherever necessary and essential investigations to diagnose infective disorders were performed. CD4+ counts were estimated by the Fluorescence-Activated Cell Sorter (FACS) system, based on flow cytometry. Pregnant mothers and children below 18 months were excluded from this study.

HIV positivity was maximum in the age group of 25- 34 years with 146 (47.9%) patients and lowest above 45 years where only 15 cases (4.9%) were recorded. Twenty six (8.5%) children below 15 years made up the bulk of pediatric patients. Seventy one respondents (23.3%) in 35-44-year group and 44 persons (14.7%) in 15-24-year category completed the population.

Most of the cases (136 respondents) reported in the late stage of HIV (44.6%) and 35 more (11.5%) had advanced HIV disease. Only 30 patients (9.8%) presented in the early asymptomatic period.

Males (210 cases, 68.9%) outnumbered females (95 cases). Major mode of acquisition of HIV disease was heterosexual (88.7% cases). Fifteen males admitted to having sex with males while only two in the group were discovered to be chronic intravenous drug abusers.

Majority (11.50%) of patients was in the candidiasis group [Table - 1]. Fifteen were diagnosed with idiopathic pruritus after all known itchy diseases were excluded.

Molluscum contagiosum formed the largest group among viral infections and presented with a mean CD4+ cell reading of 98 cells/mm 3 . Seborrheic dermatitis was found in only 8.5% of our respondents. Fungal and viral sections presented with mean CD4 cell counts below 200 cell/mm 3 [Table - 1]. Only 33 seropositives did not have any cutaneous features and this group had the highest mean CD4 cell count of 311.24 cell/mm 3 .

Recent reports [2] about HIV/AIDS in India mention that most infections are in the productive section of 15-44 years, as in this report. HIV/AIDS control programmes are apparently not reaching the efficient age group of this hilly terrain. Ignorance, fear of social segregation preventing many to disclose their ailment and inability of people living in remote places to reach such specialized centers are possibly acting as hindrance for timely consultation. Majority of the affected were males and trend was similar to the national picture. [2]

Paucity of persons reporting homosexual behaviour as seen among HIV seropositives here has been identified as the cause of rarity of Kaposi′s sarcoma among HIV positive individuals in this region. [3] Candidiasis was the most common mucocutaneous disorder in our HIV cases as observed in other studies in India. [1] Even after careful clinical scrutiny, we could not find any opportunistic deep fungal infection like cryptococcosis, histoplasmosis and penicillosis perhaps because this is not an endemic area for these ailments. Pruritic papular eruptions constituted substantial number of patients who presented with intractable pruritus of undefined cause as was observed in south India. [1] Pruritic papular eruption of HIV was also found to be the commonest cutaneous manifestation in a Western study. [4] The reason for this type of undiagnosed pruritus in these immunosuppressed patients as seen in this group has been thought to be due to immune dysregulation. [5]

Low CD4+ count among molluscum contagiosum patients was similar to findings of Goldstein et al . [6] Giant and atypical varieties were seen amongst our population and lesions were commoner on the face. Seborrheic dermatitis is a common disorder in AIDS patients but few cases were recorded in our clinic. Mild and temperate climate of this region is vastly different from hot humid climate where seborrheic dermatitis predominates.

CD4+ counts in cases suffering from viral and fungal diseases were lowest and thus may act as a marker of HIV disease progression. This fact corroborates with a research done in King George Hospital. [7]

Genital infections indicate an important portal of entry for HIV and chancroid was the principal sexually transmitted infection (STI) among those examined here during this period. Recently, observers [8] have suggested that herpes simplex virus 2 (HSV-2) causing genital ulcerative disease acts as main risk factor for acquisition of HIV infection.

Kumarasamy N, Solomon S, Madhivanan P, Ravikumar B, Thyagarajan SP, Yesudian P. Dermatological manifestations among human immunodeficiency virus patients in south India. Int J Derm 2000; 39:192-5.
[Google Scholar]
Pembrey G. Who is affected by HIV and AIDS in India? [last updated 2008 Nov 4]. Available from: .[last accessed on 2009 Jan 19].
[Google Scholar]
Arendorf T, Holmes H.Oral manifestations associated with human immunodeficiency virus (HIV) infection in developing countries-are there differences from developed countries? Oral Dis 2000; 6:133-5.
[Google Scholar]
Hevia O, Jimenez-Acosta F, Ceballos PI, Gould EW, Penneys NS. Pruritic papular eruption of the aquired immunodeficiency syndrome: A clinicopathological study. J Am Acad Dermatol 1991; 24:231-5.
[Google Scholar]
Zancanaro P.C, McGirt LY, Mamelak AJ, Nguyen RH, Martins CR. Cutaneous manifestation of HIV in the era of highly active antiretroviral therapy: An institutional urban clinical experience. J Am Acad Dermatol 2006; 54:581-8.
[Google Scholar]
Goldstein B, Berman B, Sukenik E, Frankel SJ. Correlation of skin disorder with CD4 lymphocyte counts in patients with HIV/AIDS. J Am Acad Dermatol 1997; 36:262-4.
[Google Scholar]
Raju PV, Rao GR, Ramani TV, Vandana S. Skin disease: Clinical indicator of immune status in human immunodeficiency virus infection. Int J Dermatol 2005;44:646-9.
[Google Scholar]
Anuradha K, Singh HM, Gopal K, Rama Rao GR, Ramani TV, Padmaja J. Herpes simplex virus 2 infection: A risk factor for HIV infection in heterosexuals. Indian J Dermatol Venereol Leprol 2008; 74:230-3.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections