Fungal diseases in HIV and their characteristics. Oral candidiasis with HIV infection How to treat a fungal infection in HIV infected

The most dangerous disease is HIV infection, because patients are often sick due to weak immunity. They are especially susceptible to mycotic infections. The fungus in HIV actively affects the patient already in the first years of immunodeficiency, therefore such diseases are the first symptoms of the disease. In case of untimely treatment, they significantly reduce the duration of a person's life.

Reasons for the appearance

With HIV, after 3 weeks of infection, the immune system begins to weaken, fighting the virus. As a result, microflora imbalance occurs. Useful cells on mucous tissues die out, and their place is filled with fungal bacteria that also live in the human body. They actively grow, affecting organs and tissues. As a result of such disorders, allergic restructuring occurs, which leads to eczema, subcutaneous nodes and ulcers throughout the body.

Types of fungal diseases in HIV

Candidiasis with HIV

Mycotic infection with HIV extensively affects the oral cavity. Also, the fungus spreads to the surface of the tongue and the back of the pharynx. Possible localization of pathology under the armpits, between the buttocks and in the genital area. For candidiasis with HIV, the following symptoms are characteristic:

• white, creamy plaques on mucous membranes;
• spots of bright red color;
• cracks or sores in the corners of the mouth.

Fungal diseases are diagnosed using urine and blood tests for the presence of Candida fungus, and the fungus is also tested for its resistance to drugs. The main task in the treatment process is to combat the problem and increase immunity. The patient is admitted to the hospital and given daily drips with antimycotic drugs for 14 days. Further, the doctor prescribes an individual course of therapy based on the patient's condition.

A dermatologist can diagnose and prescribe the appropriate treatment for a skin disease.

Pityriasis versicolor affects the entire body of an HIV-infected person. Spots up to 5 mm appear on the patient's torso and face, which are characterized by:

• lack of discomfort (itching, pain);
• yellow-brown color;
• uneven edges;
• slight peeling;
• gradual growth into large foci.

Diagnostics is carried out using a visual examination and an iodine test, in which the patient's body is smeared with iodine and then an alcohol solution. With a positive result, the spots turn dark brown. Additionally, microscopic analysis of the exfoliated skin is performed. Treatment consists in the fact that the HIV-infected takes fungicidal and keratolytic agents, and also monitors hygiene.

Cryptococcosis

First, cryptococcosis affects the lungs, then the fungal infection spreads throughout the body, affecting the brain, skin and mucous membranes. The main symptoms include:

• coughing up discharge;
• headaches;
• shortness of breath;
• vomiting reflex;
• high fever;
• red rash, purulent nodes.

Diagnosis is by tests of blood, cerebrospinal fluid, and sputum for the presence of fungus. Treatment for HIV is carried out with antimycotic drugs. In the early stages of the disease, the patient is prescribed a course of Intraconazole. In advanced cases, life-long use of "Fluconazole" is prescribed.

The fungus affects the skin, peeling and redness of the infected areas appears.

Rubrophytia affects any part of the skin. In HIV-infected people, fungal infection is symptomatic of seborrheic dermatitis. It is characterized by:

• a large red rash that is flaky and itchy
• flat papules.

The presence of infectious agents is checked by microscopic examination. Laboratory tests make it possible to differentiate the disease from other fungal and skin diseases. Treatment is aimed at removing inflammatory process, and then removing the fungus with fungicidal ointments.

Sporotrichosis

Sporotrichosis affects the skin in most cases. However, with HIV infection often spreads to the lungs, brain, bones, and joints. The first symptoms of the disease are the development of painless pink-purple nodes on the skin. When the fungus enters the body, the disease takes on a severe and life-threatening form. Depending on the location, the patient is worried about the following symptoms:

• nausea;
• cough;
• dyspnea;
• fever;
• depression;
• sleep problems.

The disease is diagnosed using sputum and synovial fluid tests. Treatment for infection depends on the site of the infection. With skin lesions, the patient treats the body with a solution of "Potassium Iodide" for six months. In case of damage to bone tissue and lungs, the use of the drug is delayed up to a year. For the treatment of the brain, "Amphotericin" is used. Sometimes the disease requires surgery.

Collapse

Candidiasis is a disease caused by a fungus. The pathogen is embedded in the epithelial cells, disrupting their work. The disease is characterized by severe itching, burning sensation of the mouth, as well as the appearance of a continuous curd mass, which is based on dead cells of epithelial tissue.

Candidiasis in HIV infection is a particularly common occurrence. The disease almost always affects the body of infected people.

Why candidiasis often occurs with HIV infection

The disease starts small. The mucous membrane of the oral cavity, the back of the pharynx, and the digestive organs is affected. When it comes to women, vaginal disease is often present.

If the pathology is not diagnosed in time and treatment is not started, then complications develop that can not only worsen the patient's quality of life, but also lead to his death.

Interestingly, an analysis for the presence of candidiasis in the body can show a negative result only in HIV-infected patients, if there is no immunodeficiency virus in the body, then the test will always show a positive result, regardless of the degree of development of the disease.

Treatment of candidiasis in patients with HIV

To avoid the question of how to treat this disease, you need to take care of quality prevention in advance. So, people with a low immune status are often prescribed the drug Diflucan. Doctors claim that he is able to prevent the onset of the disease. However, there is an opinion that this medicine should not be taken for a long time, since fungal substances adapt to it and produce protective enzymes.

If candidiasis made itself felt, and you did not find signs of this disease in yourself, you need to follow these recommendations:

• Natural yogurt is able to inhibit the growth of fungus, so try to include this product in your diet as often as possible;
• Oral hygiene is important, since fungal organisms are unlikely to multiply under sterile conditions;
• Concerning vaginal candidiasis, then choose underwear made from natural fabrics to avoid this unpleasant phenomenon.

If the disease manifests itself, then you need to immediately visit a doctor. He will prescribe the appropriate medications, prescribe treatment and give good recommendations. You cannot self-medicate, because the immune system of an HIV-infected person is already vulnerable, and you can provoke its decline by choosing the wrong treatment.

Usually, for candidiasis in infected people, the following drugs are prescribed:

• Clotrimazole. These are pills to be taken up to 5 times a day for 2 weeks. They cannot be chewed or swallowed, they just dissolve in the mouth. An upset stomach is a side effect of taking it;
• Nystatin. The regimen is similar to the previous drug. The medicine does not cause side effects;
• Amphotericin B. A certain amount of liquid is placed on the tongue about 4 times a day. Drops should be kept in the mouth as long as possible;
• Clotrimazole is a drug used to treat vaginal candidiasis. The form of release of the drug is a cream, but sometimes suppositories are also used. You need to use the drug for one week;
• Miconazole. The treatment regimen with this drug is similar to the previous one;
• Terconazole works in the same way as the two previous drugs, but its scheme of action is more perfect. He is able to eliminate candidiasis in 3 days;
• Itraconazole. This is a medicine for the treatment of esophageal pathology. The tablets are usually taken three times a day for one month;
• Ketoconazole. The regimen for taking this medication is selected by the doctor for each patient on an individual basis.

If the fungus becomes resistant to many types of drugs, then treatment is carried out in a hospital setting. Most often, droppers are used, through which strong or even aggressive drugs are injected that can defeat the causative agent of the disease.

The incidence of HIV infection (HIV - Human Immunodeficiency Virus) continues to grow steadily. The number of patients with late stages of HIV infection and the presence of various opportunistic diseases, in particular, skin lesions, has significantly increased. Diagnosis of these changes is often very difficult at the prehospital level for general practitioners, as well as dermatologists and infectious disease specialists.

Among the many specific manifestations of HIV infection and opportunistic diseases, skin lesions occupy a special place, since already from the moment of manifestation of the disease they are the most frequent and early manifestation of it. The involvement of the skin in the pathological process is due to both immunodeficiency in general and the fact that HIV infects not only T-helper lymphocytes, but also Langerhans cells, which play an important role in dermal immune responses and, possibly, are the site of primary HIV replication in the skin ...

In 2011-2014. In ICB No. 2, where more than 80% of HIV-infected patients in Moscow are hospitalized, we observed 586 patients with various skin manifestations, which amounted to 69% of the total number of hospitalized patients (in the 4th stage of HIV infection - 88%). They can be divided into 3 groups: skin manifestations during the manifestation of HIV infection, diseases in the stage of secondary manifestations (stage 4) and skin lesions not associated with HIV infection. Skin lesions can be of great diagnostic value. Often in the early stages of the development of the disease (already 3-4 weeks after infection), an acute exanthema (3rd place after mononucleosis-like syndrome and lymphadenopathy), consisting of separate erythematous spots and papules, may appear on the patient's skin. A maculopapular rash is a kind of skin lesion in HIV-infected people, which has not yet received a certain nosological status. The rash is common, usually with mild itching. It is localized mainly on the upper half of the body, neck and face; the distal extremities are rarely affected. Papular rash is considered as a manifestation of the morphological response of the skin to HIV infection. Changes in the skin are accompanied by fever, changes in the mucous membranes of the oropharynx (more often oral candidiasis). After the acute phase subsides (2-2.5 weeks), spots and papules undergo spontaneous regression. Exanthema in acute HIV infection does not differ in morphological specificity, therefore, patients are most often sent to the hospital with diagnoses: acute respiratory viral infection, toxic-allergic reaction, measles, rubella. It should be noted that the state of the immune status in this category of patients does not have significant deviations from the norm, and the blood test for HIV by the enzyme-linked immunosorbent assay has questionable or negative results, since specific antibodies are not yet available. In the early stages, the diagnosis of HIV infection can only be confirmed by the polymerase chain reaction method. Serological reactions to HIV in these patients become positive later, more often after 6-12 weeks from the onset of the acute phase of the disease.

A third of HIV-infected patients within a few weeks from the start of treatment for various opportunistic infections with etiotropic drugs, as well as ARVT, developed a widespread itchy rash in the form of erythematous spots and papules, which was regarded as a drug toxicoallergic reaction. We also observed more severe drug reactions, in particular Stevens-Johnson syndrome and toxic epidermal necrolysis.

Thus, despite the fact that there are quite a lot of clinical variants of dermatological manifestations of HIV infection, such skin lesions as Kaposi's sarcoma, persistent candidiasis of the skin and oral mucosa, often recurrent herpes simplex and herpes zoster, seborrheic dermatitis, molluscum contagiosum, "hairy »Leukoplakia of the tongue and vulgar warts should be attributed to the most characteristic and diagnostically significant markers of HIV infection, especially if they occur against the background of common symptoms - fever, lymphadenopathy, weakness, diarrhea, weight loss. It should be noted that in the dynamics of the disease, various skin lesions can regress, reappear, replace one another, give various combinations.

Considering all of the above, patients with HIV infection with lesions of the skin and mucous membranes need constant monitoring by a dermatologist. To achieve a positive effect from the treatment carried out, longer courses of therapy for skin diseases and the maximum doses of the drugs used are needed, and after the cure, the indicated drugs are taken prophylactically. In addition to the treatment of skin diseases, patients with HIV infection are indicated for the appointment of ART. Diagnostics skin manifestations is of great practical importance, as it contributes to the earlier establishment of the diagnosis of HIV infection, timely prescription of ART, improvement of the patient's quality and life expectancy.

Literature

1. Bartlett J., Galant J., Pham P., Mazus A.I. Clinical aspects of HIV infection. M .: Garnet. 2013.590 s.
2. HIV infection and AIDS / Ed. V., V. Pokrovsky. 2nd ed., Rev. and add. M .: GEOTAR-media, 2010.192 p. (Series "Clinical guidelines").
3. Motswaledi M. H., Visser W.The spectrum of HIV-associated infective and inflammatory dermatoses in pigmented skin // Dermatol Clin. 2014; 32 (2): 211-225. doi: 10.1016 / j. det.2013.12.006. Epub 2014 Jan 22.
4. Rane S. R., Agrawal P. B., Kadgi N. V., Jadhav M. V., Puranik S. C. Histopathological study of cutaneous manifestations in HIV and AIDS patients // Int J Dermatol. 2014; 53 (6): 746-751. doi: 10.1111 / ijd.12298. Epub 2013 Dec 10. PMID: 24320966.
5. Zacharia A., Khan M. F., Hull A. E., Sasapu A., Leroy M. A., Maffei J. T., Shakashiro A., Lopez F. A. A.Case of disseminated cryptococcosis with skin manifestations in a patient with newly diagnosed HIV // J La State Med Soc. 2013; 165 (3): 171-174.
6. Mischnik A., Klein S., Tintelnot K., Zimmermann S., Rickerts V.Cryptococcosis: case reports, epidemiology and treatment options // Dtsch Med Wochenschr. 2013 Jul 16; 138 (30): 1533-8. doi: 10.1055 / s-0033-1343285.
7. Ngouana T. K., Krasteva D., Drakulovski P., Toghueo R. K., Kouanfack C., Ambe A., Reynes J., Delaporte E., Boyom F. F., Mallié M., Bertout S. Investigation of minor species Candida africana, Candida stellatoidea and Candida dubliniensis in the Candida albicans complex among Yaoundé (Cameroon) HIVinfected patients // Mycoses. 2014, Oct 7.doi: 10.1111 / myc.12266.
8. Barnabas R. V., Celum C. Infectious Co-factors in HIV-1 transmission Herpes Simplex Virus type-2 and HIV-1: New Insights and interventions // Curr. HIV Res. Apr 2012; 10 (3): 228-237.
9. Gouveia A. I., Borges-Costa J., Soares-Almeida L., Sacramento-Marques M., Kutzner H. Herpes simplex virus and cytomegalovirus co-infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus // Clin Exp Dermatol. 2014, Sep 23.
10. Gbabe O. F., Okwundu C. I., Dedicoat M., Freeman E. E.Treatment of severe or progressive Kaposi's sarcoma in HIV-infected adults // Cochrane Database Syst Rev. 2014, Aug 13; 8: CD003256.
11. Duggan S. T., Keating G. M. Pegylated liposomal doxorubicin: a review of its use in metastatic breast cancer, ovarian cancer, multiple myeloma and AIDS-related Kaposi’s sarcoma // Drugs. 2011, Dec 24; 71 (18): 2531-2558.
12. Hu Y., Qian H. Z., Sun J., Gao L., Yin L., Li X., Xiao D., Li D., Sun X., Ruan Y. et al. Anal human papillomavirus infection among HIV-infected and uninfected men who have sex with men in Beijing // J Acquir Immune Defic Syndr. 2013, Sep 1; 64 (1): 103-114.
13. Videla S., Darwich L., Cañadas M. P., Coll J., Piñol M., García-Cuyás F., Molina-Lopez R. A., Cobarsi P., Clotet B., Sirera G. et al. Natural history of human papillomavirus infections involving anal, penile, and oral sites among HIV-positive men // Sex Transm Dis. 2013, Jan; 40 (1): 3-10.

M.V. Nagibina *, 1, candidate of Medical Sciences
N. N. Martynova **, candidate of Medical Sciences
O. A. Presnyakova **
E. T. Vdovina **
B. M. Gruzdev ***, Candidate of Medical Sciences

The rash with HIV infection is diverse and difficult to diagnose on prehospital stage... It is the most frequent and early manifestation of the disease. At different stages of HIV infection, lesions of the skin and mucous membranes are recorded in 70 - 84% of patients. Suppression of the immune system caused by the immunodeficiency virus (HIV) leads to the development of infectious and inflammatory processes in patients, often occurring with an atypical picture and a wide range of pathogens. There is a steady increase in HIV patients. The number of patients with various AIDS-associated and opportunistic diseases, including those with lesions of the skin and mucous membranes, is increasing.

Figure: 1. The photo shows a patient with HIV infection at the AIDS stage.

Pathogenesis of skin lesions in HIV infection

HIV virions infect cells that have the main viral CD4 receptors on their surface - T-helpers, macrophages, monocytes and follicular dendritic cells.

Langerhans cells (a subtype of dendritic cells) are located in the prickly and basal layer of the epidermis. They react to HIV antigens, capture them, process them and deliver them to the lymph nodes for presentation to resting T-lymphocytes, causing the development of immune and cytotoxic reactions.

Infected dendritic cells, upon contact with T-lymphocytes, cause massive viral replication and the following massive death of T-lymphocytes, which are eliminated from the skin and lymph nodes.

Skin manifestations that occur in infectious and non-infectious diseases that develop with HIV infection are based on the damage to the cells of the immune system and the direct effect of immunodeficiency viruses, for example, in human papillomavirus infection.

Figure: 2. In the photo on the left, intraepidermal macrophages (Langerhans cells) are a subtype of dendritic cells. Dendritic cells have numerous branched membrane processes (photo on the right).

Causes of a rash with HIV infection

The rash is a pathological element on skin and mucous membranes, which differ in appearance, color and texture from healthy tissues. In patients with HIV infection, the cause of damage to the skin and mucous membranes is bacterial, fungal and viral infections (including tumors), as well as dermatoses of unknown etiology. Lesions of the skin and mucous membranes in HIV infection are recurrent and gradually acquire a severe course, are characterized by resistance to treatment, combined with lymphadenopathy. Generalization of lesions against the background of weakness, fever, diarrhea, weight loss and lymphadenopathy indicates the progression of the disease and the transition of HIV infection to the AIDS stage.

Most often in the countries of Western Europe and the USA there are: herpes infection, candidiasis, tuberculosis, pneumocystosis, and atypical mycobacteriosis, in the territory of the Russian Federation - herpes simplex and herpes zoster, hairy leukoplakia, seborrheic dermatitis, vulgar warts, and molluscum contagiosum.

Pathologies of the skin and mucous membranes found in HIV infection:

Figure: 3. The photo shows a rash in an HIV patient with Kaposi's sarcoma.

Rash with HIV infection at the stage of primary manifestations

The rash in HIV infection in the acute febrile stage is caused by the immunodeficiency viruses themselves. During this period, the number of CD4 + lymphocytes remains more than 500 in 1 μl. The rash is represented by erythema

In the stage of primary manifestations in HIV infection, an erythematous rash (areas of redness of different sizes) and a maculopapular rash (areas of seals) are more often recorded. The rash is profuse, has a purple color, symmetrical, localized on the trunk, its individual elements can also be located on the neck and face, does not flake, does not bother the patient, has a similarity with rashes in measles, rubella, syphilis and disappears within 2 - 3 weeks even without treatment. Changes in the skin often occur against a background of increased body temperature and lesions of the oral mucosa in the form of thrush.

Sometimes patients have small hemorrhages in the skin or mucous membranes up to 3 cm in diameter (ecchymosis), with minor injuries, hematomas may appear.

In the acute stage of HIV, a vesicular-papular rash often appears, characteristic of herpes infection and molluscum contagiosum.

Figure: 4. A rash with HIV infection on the trunk is the first sign of the disease.

Rash with HIV infection of a fungal nature

And mucous membranes are most common in HIV infection. The most common are candidiasis, rubrophytosis, and pityriasis versicolor. Mycoses are more often recorded in young males. With a sharp decrease in immunity, extensive areas of damage to the skin and mucous membranes are formed. In some cases, deep mycoses develop (coccidioidosis, cryptococcosis, blastomycosis, sporotrichosis, histoplasmosis and chromomycosis), which are recorded outside the areas endemic for them. They belong to the group of opportunistic infections and are a sign of the rapid progression of AIDS.

Candidiasis

In HIV infection, the most common diseases are caused by opportunistic flora - fungi of the genus Candida — Candida albicans.

Many factors contribute to the pathological growth of pathogens, the main of which is a sharp suppression of immunity. Lesions by fungi of the genus Candida are recorded in the oral cavity, on the mucous membrane of the genitals, in the folds of the skin and in the perianal region. The disease becomes severe over time. There is a combined lesion of the skin, mucous membranes and genitals.

A gradual decrease in immunity leads to the spread of infection. The disease is difficult to treat. Distinctive feature candidiasis in HIV infection is the development of the disease in young people who have not previously received antibacterial drugs, corticosteroids or cytostatics.

Figure: 5. Damage to the oral mucosa in candidiasis. Left - an acute form of the disease. The tongue is hyperemic, the papillae are smoothed, there is a burning sensation in the mouth when eating spicy food. The photo on the right is a common oral candidiasis.

Figure: 6. Candidiasis develops in 85% of HIV patients. The photo shows a severe form of oral candidiasis.

Figure: 7. Often with HIV infection, candidiasis of the groin folds and anal region develops. Redness, itching and burning are the main signs of the disease.

Figure: 8. Candidal vaginitis. With colposcopy, areas of cheesy plaque are visible. Itching and burning in the genital area, copious cheesy vaginal discharge with unpleasant odor - the main symptoms of the disease.

Figure: 9. Acute candidiasis in women and men. Against the background of sharp hyperemia, separate areas of curdled plaque are visible.

Figure: 10. Balanoposthitis as a consequence of candidiasis (thrush) in HIV patients.

Rubrophytia

Figure: 11. Deep (left photo) and plantar (right photo) dermatophytosis are common in patients with HIV infection. With reduced immunity, pyogenic bacteria quickly penetrate into the deep layers of the skin and destroy them, and the fungus itself spreads to the entire sole.

Versicolor versicolor

Conditionally pathogenic microorganisms include the yeast-like fungus Pityrpsporum orbiculare located in the mouths of hair follicles. With a decrease in immunity, fungi penetrate into the stratum corneum of the epidermis and multiply intensively, capturing large areas of the body on the back, chest, neck, shoulders, abdomen, rarely on the skin of the extremities.

Figure: 12. Skin rash with pityriasis versicolor is common in HIV patients. It is characterized by the appearance of spots of various sizes and configurations, with a tendency to peripheral growth and fusion, sharply delineated, have a different shade - from pink to brown, more often the color of coffee with milk.

Seborrheic dermatitis

Often, HIV patients develop seborrheic dermatitis. Up to 40% of patients suffer from this disease at the stage of HIV infection, from 40 to 80% of patients - at the stage of AIDS.

Figure: 13. Type of rash in HIV patients with seborrheic dermatitis of the scalp and face.

Figure: 14. Seborrheic dermatitis of the face.

Figure: 15. Severe form of seborrheic dermatitis in AIDS.

Rash for herpes infections

Herpetic infections are recorded in every third patient with HIV infection. They are caused by α and γ-herpes viruses. Herpetic infections with HIV infection are difficult, recurrent course and atypical forms of localization are often recorded. Duration of more than 1 month in the absence of causes leading to immunosuppression is a distinctive feature of the disease.

Herpes viruses in HIV infection affect large areas, the ulcers formed are large in size and do not heal for a long time. Recurrent course of the disease is a poor prognostic sign and allows one to suspect the transition of HIV infection to the stage of AIDS. The most common rashes in HIV patients are localized on the lips and face, perianal region and genitals.

α-herpes viruses

Herpes simplex virus type 1 (Herpes simplex virus 1) affects the mucous membranes of the eyes, oral cavity, skin of the face and upper half of the body.

Herpes simplex virus type 2 (Herpes simplex virus 2) affects the skin of the buttocks and lower extremities, mucous membranes and genital skin.

Herpes simplex virus type 3 (Varicella zoster) causes chickenpox and shingles.

β-herpes viruses

Human herpes viruses of the 5th type (Cytomegalovirus) are the cause of the development of cytomegalovirus infection, human herpes viruses of the 6th and 7th types - the syndrome of chronic fatigue and depression of immunity.

γ-herpes viruses

Herpes simplex viruses type 4 (Epstein-Barr) cause infectious mononucleosis, Burkitt's lymphoma, nasopharyngeal carcinoma, hairy leukoplakia of the tongue, B-cell lymphoma, etc.

Herpes simplex viruses type 8 are the cause of Kaposi's sarcoma in AIDS patients.

Figure: 16. Herpetic ulcers on the lips in HIV infection are large, crater-like, irregular in shape with a sharply hyperemic bottom (photo on the left). Herpetic keratitis (photo on the right) often results in blindness.

Figure: 17. Type of rash in HIV patients with the defeat of the herpes viruses of the facial skin. The rash is multiple and a poor prognostic sign.

Figure: 18. Recurrent herpes in a patient with AIDS.

Figure: 19. Herpes lesions of the skin of the face and mucous membranes of the lips in patients with sharply reduced immunity. In the photo on the right is a hemorrhagic form of herpes.

Figure: 20. With widespread rashes, the disease is often complicated by the addition of a secondary infection, which is observed in persons with sharply reduced immunity.

Figure: 21. Herpes zoster is most severe in adults with severe immunodeficiency. The recurrent nature of the disease, persistent lymphadenopathy and the combination with Kaposi's sarcoma indicate the development of AIDS in the patient. Shingles has multiple manifestations - from vesicular rashes to severe hemorrhagic and necrotic lesions. Its appearance in people from risk groups is an indication for testing for HIV infection.

Figure: 22. Herpes rash in the perineum. The skin of the woman's buttocks and external genital organs is affected.

Figure: 23. The photo shows genital herpes in a woman (atypical form) and a man.

Figure: 24. In HIV patients, herpetic proctitis often develops, manifested by painful erythema and edema of the perianal region.

Figure: 25. Type of rash with chickenpox. Chickenpox in HIV patients has a long course - from several weeks to several months. Often, after recovery, the disease resumes again (relapses).

Figure: 26. "Hairy leukoplakia" occurs mainly in HIV-infected patients. It is caused by herpes simplex virus type 4 (Epstein-Barr). Milky-white warty formations are located in the oral cavity along the edge of the tongue, the mucous membrane of the cheeks along the bite, the red border of the lower lip, less often on the mucous membrane of the glans penis, clitoris, vulva, vagina and cervix. There have been cases of cancerous degeneration.

Figure: 27. Kaposi's sarcoma belongs to the group of mesenchymal tumors of vascular tissue and is a pathohomonic sign of HIV infection. It occurs in 90% of AIDS patients, young people (up to 35 years old). In a third of them, the rash is localized in the oral cavity. The disease is common and progresses rapidly.

Figure: 28. Spots, nodules, plaques and tumor-like formations are characteristic signs of a rash in HIV patients with Kaposi's sarcoma. The lower the immunity, the shorter the patient's life. Up to 80% of them die within the first 2 years.

Figure: 29. Non-nodal (extranodal) highly differentiated non-Hodgkin B-cell lymphomas in the AIDS stage are recorded in 46% of patients. The disease affects the central nervous system, gastrointestinal tract, liver and bone marrow.

Figure: 30. Burkitt's non-Hodgkin's lymphoma is a high-grade tumor. It develops from B-lymphocytes, quickly spreads outside the lymphatic system. Intoxication, fever, emaciation, night sweats and local itching, swelling of the jaw and neck, intestinal obstruction and bleeding are the main symptoms of the disease.

Rash with HIV infection of a poxvirus nature

In people with HIV infection, a rash on the face, neck, chest, armpits, back of the hands, forearms, pubic area, external genitals, and inner thighs may be a manifestation of molluscum contagiosum. It is caused by two types of poxviruses (smallpox viruses). Persons with weakened immunity are most susceptible to the disease. When molluscum contagiosum multiple rashes appear on the skin, having a hemispherical shape, the size of a pinhead of pinkish or milky color with an umbilical impression in the center, reaching sizes up to 1.5 cm.In the nodules, a white curdled mass is distinguished, which is the habitat of viruses. With AIDS, the disease progresses rapidly.

Figure: 31. The photo shows a rash with molluscum contagiosum.

Rash with HIV infection of human papillomavirus nature

Human papillomaviruses (HPV) are infected up to 70% of the world's population. More than 100 types of viruses have been studied today. In HIV-infected patients, papillomavirus infection is often the cause of a rash on the skin and mucous membranes.

• Non-oncogenic HPV cause the development of plantar and vulgar warts.
• Oncogenic types of viruses low degree of malignancy are the cause of genital warts, endourethral warts, cervical warts, warty epidermrmodysplasia, laryngeal papillomatosis, giant condyloma Buschke-Levenshtein, verruciform epidermodysplasia of Lewandowski-Lutz.
• Oncogenic types of papillomaviruses of a high degree of malignancy are the cause of the development of flat warts, dysplasia of the cervix, cancer of the cervix and vagina, external genitalia in men and women, the anus.

In HIV patients, the incidence of diseases caused by HPV increases significantly. Their course is heavy and protracted. Atypical localizations are characteristic.

Figure: 32. The appearance of vulgar warts is often noted in HIV patients. They are multiple, gradually increase in size, the process tends to generalize.

Figure: 34. Genital warts are often recorded in HIV patients and depend on the number of sexual partners. The lower the immunity, the more condylomas grow, up to the formation of extensive conglomerates.

Figure: 35. Genital warts in the anus and on the tongue are a common sign of HIV infection. They occur after sexual intercourse.

Figure: 37. Human papillomavirus is the cause of dysplasia (left photo) and cervical cancer (right photo). Promiscuous sex life contributes to the spread of infection. Dysplasia of the cervix in 40 - 64% of cases degenerates into a cancerous tumor. The normal immune system inhibits this process for many years (15 - 20 years). With a weak immune system, the transition to a cancerous tumor occurs within 5 to 10 years.

Rash with HIV infection of a bacterial nature

Against the background of a sharp suppression of the immune system, HIV patients often develop superficial and deep strepto- and staphyloderma in the form of folliculitis, impetigo, ecthyma and cellulite.

Figure: 38. Type of rash in AIDS patients with bacillary angiomatosis. The cause of the disease is bacteria of the genus Bartonella. Papules of purple or bright red color, forming painful nodes - the main elements of the rash in bacillary angiomatosis.

A rash with HIV infection allows not only to suspect manifestations of immunodeficiency, but also to predict the course of the disease and to prescribe antiretroviral therapy in a timely manner.

Articles of the section "HIV infection"Most popular

Candidiasis is one of the fungal infections caused by a fungus of the genus Candida. Candidiasis with HIV can be more intense and pose a direct threat to life. In a moderate amount in the microflora of every healthy person there is this fungus. Some people are active carriers of the fungus without feeling any discomfort. But the pathology in HIV-infected has obvious manifestations and can cause death. In a supposedly healthy person, it could be a sign of HIV infection.

Development reasons

Everyone has a fungus of the genus Candida, but it may not cause diseases or pathologies in a healthy person with sufficient body resistance. The development can be provoked by a weakening of the protective function of the body (local immunodeficiency) or the human immunodeficiency virus (HIV). Therefore (it affects the nasopharyngeal mucosa), which manifests itself in the early stages in 90% of HIV-infected people, is considered one of the markers of a fatal disease.

Candida albicans is not limited to AIDS. Even those strains and manifestations of the fungus that occur in HIV patients can be signs of hypovitaminosis, dysbiosis, or a consequence of taking antibiotics in a person who is not a carrier of HIV infection.

What are the symptoms of concern?

Most often, with HIV, candidiasis of the oral mucosa occurs.

Most often, Candida affects the mucous membranes of the body - the mouth, genitals, it can also develop in the corners of the mouth, provoking angular cheilitis, in the folds of the skin - under the breasts in women, in the axillary and gluteal folds, in the perineum and even in the interdigital folds on the hands. More rare is the manifestation of the fungus of the genus Candida on smooth skin. The symptoms of the disease are shown in the table:

A kind of candidiasis	Typical symptoms
Oral candidiasis	It manifests itself as a white coating on the tongue, palate arch and cheek mucosa. There may be painful sensations when eating, a burning sensation in the mouth.
Thrush in women	Regular cheesy discharge, itching, pain during sex, discomfort when urinating, unpleasant odor.
Candida cheilitis	Painful cracks (bumps) in the corners of the mouth, covered with a whitish coating that can be easily removed.
Fold candidiasis	It manifests itself as erosions of crimson color, can have a bluish tint and peeling of the skin along the edges.
Smooth skin candidiasis	It manifests itself in the same way as candidiasis of the folds and, usually, is its consequence.

Feature of the flow

Candidiasis in HIV-infected people often forms in the mouth. Later, it can manifest itself with candidal cheilitis. In people infected with AIDS, the fungus is prone to rapid development, relapse and manifestation of obvious symptoms of the disease in a short time. The mouth can pass very quickly into the esophagus and cause digestive problems, up to the blockage of the digestive tract due to swelling of the mucous membrane. Also, AIDS patients are characterized by atypical forms of the fungus. For example - folliculitis, which can cause ulcers at the site of the follicle, and later - partial baldness.

Candidiasis in this combination is rarely curable due to weak immunity.

Features of the course in HIV-infected:

• It appears more often in men with HIV than in women.
• Treatment rarely works.
• Oral candidiasis with HIV occurs in 20% of cases, less often in the genital and perigenital areas.
• Cheilitis manifestations spread faster and with high intensity.
• In HIV-infected, atypical strains of the fungus may develop.