Diagnosis
In cases of chronic mucocutaneous ulceration suspected to be secondary to CMV or EBV infection, biopsy for histopathological assessment is necessary to make the diagnosis.
Dermatological Conditions
Management
Improvement of mucocutaneous lesions of CMV and EBV following commencement of ART have been reported in the setting of advanced HIV infection. (48) Systemic antiviral therapy is indicated for CMV infection in immunocompromised patients, and may involve oral valganciclovir or intravenous ganciclovir for up to six weeks. Oral valganciclovir may be continued as secondary prophylaxis …
Human papilloma virus (warts)
In general, human papillomavirus (HPV) infections are considered benign. However, HPV subtypes 16, 18 and several others have oncogenic potential and have been shown to be associated with malignant transformation. (51) Neoplastic transformation to squamous cell carcinoma can occur in association with HPV infection of the skin, oral mucosa cervix, vulva, penis and anogenital mucosa. Precursor …
Diagnosis
The diagnosis of HPV warts is usually clinical. A biopsy may be helpful in establishing a diagnosis, particularly in verrucal lesions unresponsive to therapy or when warts have unusual features, such as hyperpigmentation, ulceration, rapid growth or excessive bleeding. (59) At mucosal sites, premalignant lesions (e.g. penile or vulval HSIL) caused by HPV can be …
Management and prevention
Treatment of cutaneous and anogenital warts is directed on the alleviation of signs and symptoms with traditional treatment modalities focusing on the destruction of infected tissue. First-line treatments for warts include cryotherapy or keratolytics such as topical salicylic acid-based preparations, either separately or in combination. (53) Refractory warts may require referral for off-label therapies, such …
Molluscum contagiosum
Molluscum contagiosum (MC) virus is a poxvirus that causes a localised cutaneous infection most often seen in children. MC is spread by direct skin-to-skin contact, occurring anywhere on the body except the palms of the hands and soles of the feet. In people living with HIV, prevalence of MC has been reported to be as …
Clinical presentation
Clinical presentation Classically, MC presents as dome shaped, flesh-coloured 2-6 mm papules with central umbilication (70) In PLWHIV who are virally suppressed, MC lesions may not differ clinically to people without HIV, whereas in advanced HIV can be more numerous, larger and verrucous in morphology. (71, 72) .
Diagnosis
The diagnosis of MC is usually clinical although a biopsy of the papules may be required if alternate diagnoses (eg mpox, cutaneous cryptococcus, talaromycosis, histoplasmosis) are being considered.
Management
MC is usually self-limiting and spontaneously resolves after a few months in immunocompetent hosts, supporting a watchful waiting approach. (70) In the setting of advanced HIV immunodeficiency, recalcitrant lesions often improve with immune reconstitution on ART. (73) General advice about the risks of autoinoculation and spreading should be given. Genital lesions should be definitively treated …
Management and Prevention
Treatment of mpox is primarily supportive, with most cases resolving after three weeks. (76) Paraenteral nutrition and hydration may be required in patients unable to tolerate oral intake due to mucosal lesions. Antiviral treatments should be prescribed under the guidance of Infectious Diseases specialists, and may be required in severe cases or in patients with …