Elsevier

The Lancet

Volume 348, Issue 9028, 7 September 1996, Pages 659-663
The Lancet

Series
HIV-related skin diseases

https://doi.org/10.1016/S0140-6736(96)01032-XGet rights and content

Summary

Disorders of the skin and mucous membranes, including various infections, Kaposi's sarcoma, and miscellaneous conditions, occur throughout the course of HIV infection, affecting more than 90% of patients at some time. These lesions are often the first manifestations of symptomatic HIV disease. Clinicians need to be aware of these diagnoses and the order of their appearance since correct interpretation is essential for counselling patients about the progression of their illness and for initiating appropriate therapy.

Section snippets

Skin immune system

Skin harbours specialised subsets of antigen-presenting dendritic cells, Langerhans cells and dermal dendritic cells, that take up microbial and tissue antigens, migrate to peripheral lymph nodes, and present processed antigens to naive T lymphocytes. The T lymphocytes are thereby induced to become activated and to expand in number, and T cells so activated acquire the capacity to migrate preferentially to skin, directed by specific homing receptors, where they exert their effector functions

Cutaneous signs of primary HIV-1 infection

Although primary HIV-1 infection is commonly symptomless, an acute febrile illness lasting 1–2 weeks and resembling infectious mononucleosis is sometimes identifiable.8, 9 The interval between exposure to HIV-1 and the development of this acute illness ranges from 3 to 6 weeks, and seroconversion takes place shortly therafter.8, 9 In addition to fever and constitutional symptoms, as many as 75% of patients with symptomatic primary infections also develop skin lesions,8 including

Viral infections

Viruses other than HIV-1 are common pathogens in HIV-1 disease and are probably important infectious cofactors for disease progression. These opportunistic infections range from relatively benign disorders such as cosmetically disfiguring molluscum contagiosum to severe infections of the skin and mucous membranes such as ulcerating herpes simplex. Oral hairy leukoplakia, which is attributed to Epstein Barr virus infection, is described by Greenspan and Greenspan in this series.

Herpes simplex

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