CUTANEOUS FINDINGS IN HIV-1-POSITIVE PATIENTS - A 42-MONTH PROSPECTIVE-STUDY

Background: Cutaneous disease is common in patients infected with HIV- 1. Objective: The aim of our study was to identify cutaneous markers a ssociated with HIV-1 infection and disease progression as measured by Walter Reed (WR) stage. Methods: For 42 months we have observed 912 HI V-1-positive patients in all WR stages. All patients had an extensive past and present medical history taken as well as a complete physical examination, periodic visits, and appropriate diagnostic procedures. R esults: Increasing dryness of the skin and seborrheic dermatitis are e arly findings in a large percentage of patients in WR stage 1; the occ urrence and severity of both conditions increase with disease progress ion. Tinea infections, condylomata acuminata, and verrucae are seen ea rly, but with disease progression, although there is no dear increase in occurrence, these infections become more diffuse and resistant to t reatment. Flares in acne vulgaris and folliculitis show a peak occurre nce in early and mid-stage disease with a decreased occurrence in late -stage disease. Herpes simplex infections, oral candidiasis, molluscum contagiosum, Staphylococcus aureus infections, and oral hairy leukopl akia show a marked increase in occurrence with advanced disease. Condi tions that have a statistically significant association with disease p rogression as measured by a change in stage include drug eruptions, se borrheic dermatitis, oral candidiasis, oral hairy leukoplakia, mollusc um contagiosum, herpes tester, and hyperpigmentation (nail, oral, skin ). Conclusion: The most frequent and persistent cutaneous disorders we re asteatosis (with or without asteatotic eczema) and seborrheic derma titis. Conditions that were associated with a change in WR stage inclu de drug eruptions, seborrheic dermatitis, oral candidiasis, oral hairy leukoplakia, molluscum contagiosum, herpes tester, and hyperpigmentat ion. In addition to Kaposi's sarcoma, patients with HIV-1 disease have an increased potential. for the de development of both cutaneous epit helial and probably melanocytic malignancies. Epithelial tumors were s een in patients in all stages of disease.