In today's discussion, we're diving deep into the world of skin conditions associated with HIV. This is a crucial topic for both healthcare professionals and individuals who want to understand more about the manifestations of HIV. The video we’ll be referring to includes numerous clinical photographs, as visual aids are invaluable for grasping the complexities of this subject.

To kick things off, let's define HIV. HIV stands for Human Immunodeficiency Virus, a retrovirus that leads to a significant reduction in the number of CD4 T cells in the host. This reduction impairs the body's ability to fend off infections, which, as we'll see, can manifest in various skin diseases. Without proper treatment, HIV can progress to its advanced stage, known as Acquired Immunodeficiency Syndrome (AIDS).

So, why is it important to recognize skin diseases in the context of HIV? First and foremost, skin conditions are extremely common among those infected with HIV—around 90% of patients will develop some form of skin issue. These conditions tend to become more prevalent as HIV progresses and immune function declines. Importantly, skin conditions can be early indicators of HIV infection. For healthcare professionals, recognizing these signs and testing for HIV can lead to earlier detection and treatment, ultimately improving patient outcomes.

Let’s delve into the types of skin diseases associated with HIV. A systematic approach works best, dividing them into infectious and non-infectious causes. Infectious causes can be further broken down into fungal, bacterial, viral, and parasitic infections.

Starting with fungal infections, there are several types that can occur at varying levels of immunocompromise in HIV patients. Tinea, commonly known as ringworm, can affect any part of the body. Onychomycosis is a fungal infection of the nails, while candidal infections, or thrush, can impact the mouth and, in severe cases, spread to the esophagus. These infections may be more aggressive and less responsive to typical treatments in HIV patients. If a patient presents with recurrent candida that doesn’t respond to standard treatments, it’s worth considering an HIV test.

Another fungal issue is Pityrosporum folliculitis, which causes acne-like inflammation around hair follicles. Pityriasis versicolor results in hypo- or hyperpigmented lesions on the skin. Seborrheic dermatitis, another condition associated with HIV, causes flaky, itchy, and red skin.

Next, let’s look at bacterial infections. Staphylococcus aureus can lead to folliculitis, impetigo, or abscesses. HIV patients are also at risk for mycobacterial infections and syphilis, which can increase HIV transmission.

Viral infections are also common in HIV patients. These include recurrent or chronic herpes zoster, hyperkeratotic and proliferative viral warts, and oral hairy leukoplakia. Persistent ulcerated herpes simplex, Molluscum contagiosum, and cytomegalovirus infection are also notable. Additionally, Norwegian scabies and Demodex folliculitis can affect those with HIV.

Now, let’s shift our focus to non-infectious skin issues, particularly cancerous lesions. Kaposi sarcoma is a significant concern. Before widespread use of HAART (Highly Active Antiretroviral Therapy), Kaposi sarcoma was the most prevalent malignancy in HIV patients, caused by human herpesvirus 8. It typically presents as painless red or purple lesions and is strongly associated with a declining CD4 count.

HIV patients also face a higher risk of developing squamous cell carcinoma and basal cell carcinoma—about a two-fold increase compared to the general population. Cutaneous T and B cell lymphomas and aggressive melanomas are also more prevalent among those with HIV. Another condition to note is lipodystrophy, characterized by abnormal fat distribution, which can be seen in HIV patients.

Understanding these skin conditions is vital for early detection and treatment of HIV. If you're a healthcare professional or someone interested in learning more, I encourage you to explore the additional resources linked in the description box of the video.

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