Skin and Oral Manifestations of HIV Infection

1. Skin and Oral Manifestations of HIV Infection Stephen Tabet, MD, MPH University of WashingtonHIV Vaccine Trials Network (HVTN) Seattle, Washington stabet@hvtn.org

2. Flags: The HIV Iceberg Evidence of End-Organ Disease Identification Factors Present Identification Factors Absent

3. Flags: The Goal is Early HIV Detection • Initiate appropriate preventive therapy • Generally inexpensive • Prophylaxis for opportunistic infections • Vaccinations (HBV, influenza, Pneumovax®, tetanus) • Initiate appropriate antiretroviral therapy • Use CD4+ and HIV-1 RNA thresholds • Reduce HIV transmission to others • After diagnosis of HIV, risk behavior 

4. Flags: Identification of HIV • Medical and risk behavior history • Physical exam features • Identifying flags • Photo case examples • Recognizing acute HIV infection • Laboratory features

5. Patient • Patient presents with what he describes as facial dandruff for the past several weeks.

8. Patient Presentation • The patient is seen by you and the doctor and he diagnoses him with seborrheic dermatitis. • The patient reports that he is bisexual. • Would you recommend an HIV antibody test?

9. Patient Presentation • The patient is treated with topical ketoconazole and hydrocortisone, and ketoconazole shampoo. • The patient tests HIV positive, but does not return back to clinic for his results. • How might you have gotten better success with getting him to come back for his results?

10. Patient Presentation • HIV+ patient reports to you that he has had these strange warts in his pubic area for the past several months. • Wants to know what he should do?

15. Oral HPV

16. Oral HPV (Concerning for immunosuppression)

17. Anal Warts (Condyloma)

18. Penile Warts (hyperpigmented)

19. What is one of the greatest concerns for warts especially in HIV+ patients? • 1. That it can be spread to other parts of the body • 2. That is can turn into ulcers • 3. That is can progress to cancer

20. Anal Cancer

21. 46 year old patient with AIDS presents with a severe rash

23. Itchy Patient • 32 year old new patient is in clinic complaining of itchiness since being incarcerated for the past month. • What would you do next?

26. What is the most common cause of lip and mouth ulcers is HIV+ patient?

28. 48 year old HIV+ pt with CD4 480 is being treated with mupirocin ointment for impetigo. Why is it not getter better?

31. You get the patient Ophthalmologic consultation and Slit lamp examination is normal.Which of the following is likely to reduce the duration of the patient’s herpes zoster rash? • 1. Acyclovir • 2. Zostrix cream • 3. Prednisone • 4. Fluconazole

32. Patient presents with stye; what else could it be?

33. HIV+ patient presents with a bruise on his leg.

34. AIDS patient is being treated for a keloid with intralesional steriods

35. Kaposi’s Sarcoma

36. AIDS patient with CD4 count 40 presents with nonhealing ulcer.

42. Patient with a severe rash • HIV antibody negative • HIV PCR (viral load negative) • What next?

44. How do you measure the size of a TST reaction?

46. Patient with CD4 180 and sore, red mouth. Diagnosis?