The spectrum of dermatological manifestations among HIV infected patients at AMPATH Clinic in Eldoret, Kenya

Abstract

Background: Skin and mucocutaneous diseases are common among HIV infected patients. The introduction of antiretroviral therapy (ART) has changed the spectrum of skin and mucocutaneous disorders among HIV infected patients. There is need to assess the changing spectrum of skin diseases after the introduction of antiretroviral. Currently there are few studies, which have assessed the spectrum of skin diseases in HIV infected patients in Western Kenya. Objective: To determine the spectrum of skin disorders among ART naive and ART experienced HIV infected patients attending Academic Model Providing Access to Health care (AMPATH) clinic Eldoret, Kenya. Method: This was a cross-sectional study that recruited 490 HIV infected patients who attended AMPATH clinic from October 2016 to September 2017.A systematic random sampling was used to select the patients in the study. The socio-demographic and clinical data was collected using a structured questionnaire. Full body examination was done under adequate light by the investigator and confirmed by a dermatologist. All findings were entered in to a questionnaire and digital photography was captured. A total of 13 patients had unclear diagnosis, which was confirmed with a biopsy. The data was analyzed using STATA version14, the categorical variables summarized as frequencies and percentages. Continuous variables were summarized as median and interquartile range. Pearson’s Chi Square test was used to assess association between categorical variables. Results: The prevalence of skin disorders in this study was 51.42% (95% CI 46.90, 55.93). The median age was 39 years (IQR: 32, 46) with female preponderance (70.4% vs. 29.6%). Majority of the participants, 59.30% were in WHO clinical stage I and II. The median baseline CD4 cell count was 302 (IQR 160,479) with a plasma viral load 108log10 copies/ml (IQR 0,1120log10 copies/ml). Most of the patients (60.4% 296) were on ART. The antiretroviral-naive patients had a higher proportion of dermatological disorders than antiretroviral- experienced patients (62.89% vs. 43.92%, P <0.001). Infectious disorders were more common among ART-naive, 58.1% while eczematous conditions were frequent among ART-experienced patients, 51.85 %. The median duration of skin disorder was 3months (IQR 2, 5). Conclusions: Eczematous skin disorders were more frequent among antiretroviral experienced patients while infections related skin disorders were more common among antiretroviral naive patients. A higher viral load was associated with increased frequency of skin diseases.