Orocutaneous Manifestations as Markers of Disease Progression in HIV Infection in Indian Setting

CD4, CD8 and absolute lymphocyte counts (ALC) were carried out by flowcytometry in 36 HIV-infected cases with various orocutaneous manifestations, 50 asymptomatic HIV infected individuals and 50 HIV-negative controls. Average CD4 counts and CD4 : CD8 ratio in symptomatic HIV-infected cases were found to be 245.39/cmm and 0.27 respectively, significantly lower than that of HIV-infected asymptomatic individuals (622.4 and 0.45 respectively) and HIV-negative controls (798.81 and 1.03 respectively). Patients with one (77.78%), two (19.44%) and three (2.78%) orocutaneous manifestations had average CD4 counts of280.25, 131.3 and 68/cmm respectively. All the 7 cases with oral mucosal candidiasis had CD4 counts lower than 200/cmm (average 105.28/cmm), thus fulfilling AIDS-defining criteria. Although 6 (85.71%) of the 7 cases had CD4 counts less than 200, Herpes zoster should not be considered as an AIDS-defining illness, as the HIV-infected who had had H zoster in the past had higher CD4 count (average 299/cmm). Dermatoses like seborrhoeic dermatitis and lichen planus, and some infections and infestations like scabies, bacillary angiomatosis, human papilloma virus infection, molluscum contagiosum and dermatophytosis cannot be considered as AIDS-defining illnesses per se.