Calame Antoanella - Cutaneous Manifestations of HIV Disease

Clay J. Cockerell, MD
Clinical Professor, Dermatology & Pathology Director, Division of Dermatopathology University of Texas Southwestern Medical Centre Director, Cockerell & Associates Dermpath Diagnostics, Dallas, Texas, USA

Antoanella Calame, MD
Director, Compass Dermatopathology La Jolla, California, USA

Copyright 2012 Manson Publishing Ltd

ISBN: 978-1-84076-142-9

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Antoanella Calame and Clay J. Cockerell

Wei Su, Cindy Berthelot, and Clay J. Cockerell

Kumar Krishnan, Antoanella Calame, and Clay J. Cockerell

Julia Kamalpour, Antoanella Calame, and Clay J. Cockerell

Molly V. Burns and Clay J. Cockerell

Deborah B. Henderson and Clay J. Cockerell

Peter Morrell, Antoanella Calame, and Clay J. Cockerell

Benjamin K. Stoff, Antoanella Calame, and Clay J. Cockerell

Antoanella Calame and Clay J. Cockerell

Saira B. Momin and Clay J. Cockerell

CHAPTER 11 PHOTOSENSITIVE MANIFESTATIONS OF HIV DISEASE
Shadi Kourosh, Mary Feldman, and Clay J. Cockerell

Cindy Berthelot and Clay J. Cockerell

Bryan Gammon, Antoanella Calame, and Clay J. Cockerell

Robert H. Cook-Norris, Antoanella Calame, and Clay J. Cockerell

Gabriela M. Blanco, Frankie G. Rholdon, and Clay J. Cockerell

Skin diseases are common problems in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). In many cases, the Dermatologist may be the first medical professional to encounter an individual with HIV infection. It is, therefore, vital that Dermatologists recognize the cutaneous manifestations of HIV infection and AIDS so that the diagnosis can be established as early as possible and appropriate therapy can be instituted soon thereafter. In times past, this was important to lessen the likelihood of a patient developing a life-threatening opportunistic infection. Today, following diagnosis of HIV infection, highly active antiretroviral therapy (HAART) is instituted, which can essentially eradicate HIV viral loads, rendering them undetectable and significantly lessening the patients chance of developing a complication, infectious or otherwise. Many different skin disorders may be seen in these patients ranging from infections such as lues and mycobacterial infections, to other inflammatory conditions such as drug eruptions, psoriasis, and sarcoidosis. Depending on the patients immune status, skin disorders may appear similar to those seen in immunocompetent patients or they may be unusual and bizarre especially when CD4 cell counts are low. In any event, the skin is a very common site where diseases are manifest in HIV infected patients and any medical professional who takes care of these individuals must be cognizant of these manifestations and know how to manage them.

Fortunately, HAART has transformed HIV infection and AIDS so that patients are living longer with less sequelae today than when the AIDS pandemic was rampant. Unfortunately, in some populations, individuals have developed a cavalier attitude about HIV infection thinking, erroneously, that if they become infected, they can be cured by simply taking HAART. While indeed, highly active, these medications do have side-effects and are not a cure for HIV infection. Thus, while the number of patients who present with severe infectious complications or profoundly depressed CD4 cell counts is lower than in the past, there are still a significant number of individuals who are newly-infected with HIV each year and who may present with severe immunosuppression and even life-threatening opportunistic infections. Clinicians cannot lower their guard and must maintain a high index of suspicion as HIV is still significantly endemic.

In this book, we cover the entire spectrum of HIV-associated cutaneous diseases and emphasize how they present in immunocompromised patients. Each entity is discussed in detail including its clinical presentation, histopathologic findings, and treatment. As Dermatology is a specialty that emphasizes morphology, numerous clinical and histopathological images are included in each chapter.

The book is written for any provider caring for HIV patients. It will also serve as an excellent reference for the experienced Dermatologist who may encounter these individuals either on occasion or frequently, and it will also serve as a reminder of some of the serious sequelae that may be encountered in severely immunocompromised patients.

Clay J. Cockerell, MD
Antoanella Calame, MD

Cindy Berthelot, MD
Department of Internal Medicine, University of Texas Houston Health Science Center, Houston, USA

Gabriela M. Blanco, MD
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA

Molly V. Burns, BS
University of Texas Health Science Center San Antonio, San Antonio, USA

Antoanella Calame, MD
Director, Compass Dermatology, La Jolla, California, USA

Clay J. Cockerell, MD
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA

Robert H. Cook-Norris, MD
Department of Dermatology, Mayo Rochester Medical School, University of Texas, Houston, USA

Mary Feldman, MD
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA

Bryan Gammon, MD
Department of Dermatology, University of Texas Northwestern University, Chicago, USA

Deborah B. Henderson, MD
Department of Dermatology, University of Texas Northwestern University, Chicago, USA

Loebat Kamalpour, MD
Department of Dermatology, Loyola University, Maywood, USA

Shadi Kourosh, MD
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, USA

I would like to express my appreciation to Dr. Clay Cockerell, Dr. Mary Feldman, and Dr. Antoanella Calame for the opportunity to contribute to this book, and for their encouragement and exceptional mentorship throughout the process of writing. It has been a very enriching experience to serve on this team. I would also like to thank Dr. Emitis and Sadato Hosoda, Dr. Atoosa Kourosh, and Dr. Charlotte Glenn for their support and invaluable assistance with ideas and editing.