A Guide To Lower Extremity Cutaneous Manifestations In Patients With HIV Infections
Reportedly 20 percent of people with HIV are unaware of the infection. Podiatrists may play a key role in recognizing the cutaneous manifestations of HIV and AIDS in the lower extremity and facilitating appropriate referrals. Accordingly, this author reviews various dermatological side effects and presents salient treatment options.
Acquired Immune Deficiency Syndrome (AIDS) is the loss of the body’s ability to fight infections due to the infection caused by the Human Immunodeficiency Virus (HIV). AIDS is a major health problem worldwide and was first identified in the United States in 1981. Of all the industrialized countries in the world, the U.S. is home to the largest number of people living with HIV. It is estimated that every 9.5 minutes, someone in the U.S. is infected with HIV.
More than 1 million people in the U.S. are living with HIV. Out of these people living with HIV, one out of five are unaware they are infected.
At the end of June 2008, the Centers for Disease Control and Prevention (CDC) estimated that 549,196 people are living with AIDS in America.1
The management of HIV/AIDS involves the complex coordination of many healthcare professionals.2,3 The podiatric physician can provide education to the public and medical colleagues regarding lower extremity manifestations of AIDS. Moreover, podiatric physicians can play an important role by identifying patients who are infected with HIV by being alert to the specific lower extremity signs and symptoms that may signal the presence of the disease.
Unfortunately, accurate diagnosis and proper treatment of skin diseases in both HIV and AIDS can be especially challenging and often frustrating because the presentation of common dermatoses is often exaggerated into florid cutaneous eruptions. The recognition of HIV-related skin changes may empower the podiatric physician to refer a patient to an infectious disease specialist. This could lead to the diagnosis of HIV infection in the early stages, thus allowing for initiation of appropriate antiretroviral therapy.
In addition to having a strong grasp of the pathogenesis of cutaneous skin changes in the patient with HIV, physicians must be familiar with the clinical presentations and symptoms of specific lower extremity cutaneous manifestations. Finally, one also needs to be aware of cutaneous manifestations caused by available antiretroviral agents that patients may be taking to treat HIV.
A Pertinent Overview Of Cutaneous Manifestations With HIV
Researchers have reported that HIV infection is associated with a number of common dermatological disorders.4,5 Cutaneous manifestations are common in patients with HIV infection and tend to be more frequent as immunodeficiency progresses.6 The spectrum of skin changes in HIV infection is quite wide. Some of these conditions (Kaposi’s sarcoma in particular) are unique and are considered pathognomonic for HIV disease.
On the other hand, many common skin conditions that occur in healthy individuals also occur in people infected with HIV. However, these skin conditions are frequently more severe and may be more difficult to treat. Patients with HIV disease often have several simultaneous or sequential cutaneous conditions with a progressively more intransigent clinical course.