What are the cutaneous manifestations of HIV by disease stage?

Updated: Apr 19, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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During acute primary HIV infection, a transient, generalized, morbilliform eruption may develop on the trunk and the arms. In the early asymptomatic stage of HIV disease, which may last from a few years to a decade or longer, no signs of infection other than lymphadenopathy are present.

Kaposi sarcoma can occur prior to the onset of immunosuppression. With the onset of immunosuppression, nonspecific skin changes occur, such as common disorders with atypical clinical features, including recurrent varicella zoster, numerous hyperkeratotic warts, treatment-resistant seborrheic dermatitis, and oral hairy leukoplakia.

In the later stages of HIV disease, chronic herpes simplex virus (HSV), molluscum contagiosum (MC), and cytomegalovirus (CMV) infections appear. An autopsy analysis of HIV-seropositive patients revealed that 72% had opportunistic viral infections; most patients were infected with CMV and HSV. The prevalence of clinically apparent MC infection varies from 5-18% in different series. Mycobacterial infections and mucocutaneous candidiasis occur.

A 42-month prospective study by Smith et al in 912 HIV-1–infected patients found that condylomata acuminata and verrucae are observed early, and their frequency does not increase as the disease progresses, whereas the incidence of HSV infections, MC, and oral hairy leukoplakia increases as the disease advances. [5, 6]

Verrucous herpes infection, leprosy, condylomalike molluscum contagiosum, and AIDS-associated pigmented or nonpigmented erythroderma may be seen in early HIV disease or as part of immune restoration syndrome after the initiation of antiretroviral therapy. [7, 8, 9, 10, 11] Leishmaniasis and miliary tuberculosis may be a concern in advanced HIV disease. [12, 13, 14] Diffuse or disseminated leishmaniasis may occur with HIV disease, [15, 16] including in association with the immune reconstitution inflammatory syndrome. [16]

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