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Histopathological study of pruritic papular eruptions in HIV-infected patients in relationship with CD4, CD8 counts
Vamseedhar Annam1, B R Yelikar, Arun C Inamadar
1Department of Pathology, Sree Siddhartha Medical College, Hospital & Research Centre, Tumkur, Karnataka, India. vamseedhar_a@yahoo.com
Background:
Pruritic papular eruptions (PPE) are common cutaneous manifestations in HIV-infected patients. Their frequencies, patterns and associated factors vary from region to region. There is no clear consensus on the etiology of PPE, the exact spectrum of the condition, the pathologic findings, or treatment. The present study is aimed at documenting the histopathological patterns of PPE, and their relation with CD4, CD8 counts in HIV-infected patients.
Materials And Methods:
The present study lasted for 12 months (September 2005 to August 2006). After informed consent, data on skin disorders, HIV status, CD4 and CD8 counts were obtained by physical examination and laboratory methods.
Results:
Of the 36 HIV-infected patients with clinical diagnosis of PPE, the most common histopathological patterns were prurigo simplex and eosinophilic folliculitis. The mean CD4 count of PPE was 186.49 cells/mm3 with mean CD8 count of 619.60 cells/ mm3, and the CD4:CD8 ratio was 0.32. Patients with prurigo simplex had significantly lower mean CD4 counts (50.36 +/- 30.67 cells/cmm 3 , P < 0.001) while in eosinophilic folliculitis, the mean CD8 counts were higher (1239.77 +/- 402.30 cells/cmm3).
Conclusion:
We conclude that histopathology helps in specifying the pattern of PPE and also indicates underlying immunosuppression and can be a marker of advanced HIV infection. Thus, correlation between the histopathology and immunology findings helps to know the disease process.
Insights
Histopathology of pruritic papular eruptions (PPE) in HIV patients reveals specific patterns linked to immune status. Certain patterns correlate with advanced HIV infection, indicating immunosuppression.
Area of Science:
- Dermatology
- Immunology
- Infectious Diseases
Background:
- Pruritic papular eruptions (PPE) are frequent skin issues in HIV patients.
- Etiology, spectrum, pathology, and treatment of PPE remain unclear.
- Regional variations in PPE frequency and patterns exist.
Purpose of the Study:
- To document histopathological patterns of PPE in HIV patients.
- To investigate the relationship between PPE patterns and CD4/CD8 counts.
- To assess the utility of histopathology in indicating HIV-related immunosuppression.
Main Methods:
- A 12-month observational study (September 2005-August 2006).
- Informed consent obtained from 36 HIV-infected patients with clinical PPE diagnosis.
- Data collected via physical examination and laboratory analysis of CD4/CD8 counts.
Main Results:
- Prurigo simplex and eosinophilic folliculitis were the most common histopathological patterns.
- Mean CD4 count was 186.49 cells/mm³, mean CD8 count was 619.60 cells/mm³, with a CD4:CD8 ratio of 0.32.
- Prurigo simplex linked to significantly lower CD4 counts (P < 0.001); eosinophilic folliculitis associated with higher CD8 counts.
Conclusions:
- Histopathology aids in classifying PPE patterns in HIV.
- PPE patterns can indicate underlying immunosuppression and advanced HIV infection.
- Correlating histopathology with immunological findings enhances understanding of the disease process.
