Presentation on theme: "Skin and Oral Manifestations of HIV Infection"— Presentation transcript:
1 Skin and Oral Manifestations of HIV Infection Stephen Tabet, MD, MPHUniversity of Washington HIV Vaccine Trials Network (HVTN)Seattle, Washington
2 Flags: The HIV Iceberg Identification Factors Absent Evidence of End-Organ DiseaseIdentification Factors PresentThe pyramid shown on this slide represents the spectrum of identifiable and unidentifiable factors associated with HIV infectionIn most cases patients are asymptomatic with no identification factors presentIn a smaller percentage of cases (central area of pyramid), patients manifest identification factorsIn a very small percentage of cases (near top of pyramid), patients display evidence of end-organ diseaseIdentification Factors Absent
3 Flags: The Goal is Early HIV Detection Initiate appropriate preventive therapyGenerally inexpensiveProphylaxis for opportunistic infectionsVaccinations (HBV, influenza, Pneumovax®, tetanus)Initiate appropriate antiretroviral therapyUse CD4+ and HIV-1 RNA thresholdsReduce HIV transmission to othersAfter diagnosis of HIV, risk behavior HIV testing allows clinicians to track and predict the course of the disease. It also provides a basis for initiating antiretroviral treatmentRegular education and routine recommendation for HIV testing to high-risk patients can increase the number of patients that request testingEarly identification of HIV infection results in more successful treatment regimens. This can prevent the occurrence of opportunistic infections and decrease the cost associated with treating them. Early treatment can also prevent transmission to uninfected inmates and prison staffAlternatives to routine blood tests, such as urine and oral fluid tests, may increase the likelihood that patients consent to be testedReferencesProviding services to inmates living with HIV. CDC fact sheet, AugustDHHS guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents, February 4,
4 Flags: Identification of HIV Medical and risk behavior historyPhysical exam featuresIdentifying flagsPhoto case examplesRecognizing acute HIV infectionLaboratory featuresThis slide gives an overview of the key factors involved in identification of HIV
5 PatientPatient presents with what he describes as facial dandruff for the past several weeks.
8 Patient PresentationThe 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 PresentationThe 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 PresentationHIV+ 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?
31 1. Acyclovir 2. Zostrix cream 3. Prednisone 4. Fluconazole 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. Acyclovir2. Zostrix cream3. Prednisone4. 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
56 Patient Presentation32 year old married male presents with one week of fatigue, night sweats, sore throat, and rash. He reports not knowing his HIV serostatus.Examination shows a healthy appearing male with T 38.9 C, a rash and 1/2 – 1 cm bilateral occipital, cervical and axillary lymphadenopathy
61 Patient PresentationPatient reports being married and monogamous for the past 3 yearsHe denies sex with men, but does report ‘occasional’ heroin IVDU for the past 8 yrsHIV antibody test is ordered and returns negative by ELISA and WB
62 Patient Presentation What would you do next? 1) Don’t overly alarm him. Tell him that while he currently tested HIV-negative, he still needs follow up HIV testing in another month.2) Tell him you suspect he is in the very early stages of HIV infection and is very infectious. Then repeat HIV Ab.3) Tell him you suspect he is in the very early stages of HIV infection and is very infectious. Then do an HIV RNA (viral load).
63 Patient Presentation Laboratory data HIV RNA by PCR 1.8 million copies/mlCD4+ T-cells 640 /microliterplatelet count 104,000/microliterRash, sore throat, and fatigue all resolve within 1 week. Night sweats persist for 2 weeks.