As with any clinical presentation, history taking may offer clues to diagnosis (Table 2). Note the distribution, type of rash and any other associated physical findings including: oral, hair, nail and genital changes Table 2 History essentials in the setting of cutaneous presentations HIV status Current and nadir CD4 cell count, and viral load results …
Clinical History Taking and Physical Examination Read More »
Many viral infections, including those presenting with or limited to cutaneous involvement, occur more frequently in PLWHIV. (2) Common viral skin infections include those caused by Herpesviridae (including herpes simplex-1 and -2 and varicella zoster viruses), human papilloma viruses and Pox viruses. Given the underlying immunodeficiency in this demographic, viral infections may present atypically leading …
Varicella zoster virus (VZV) may result in cutaneous disease in primary infection as well as secondary reactivation in the context of immune latency, where it is referred to as herpes zoster (HZ). (27) HZ occurs up to 20-fold more frequently in PLWHIV compared to their seronegative counterparts (28) particularly among men who have sex with …
The diagnosis of VZV infection is usually clinical, however VZV PCR of vesicular fluid should be used for confirmation. VZV IgM is detected in acute chickenpox and in about 70% of people with HZ, whereas VZV IgG cannot differentiate acute and past infection or prior immunisation. (35).
Antiviral treatment for primary VZV infection is indicated in neonates, children and adults with HIV infection or other immunodefiencies, as well those with severe disease. These include oral valaciclovir, famiciclovir or aciclovir (dosages and durations provided in Table 3). Treatment should begin within 24–48 hours of onset, however in immunocompromised patients (including people living with …
Serological studies estimate approximately 67% and 16% of the global population are living with Herpes Simplex Virus (HSV)-1 and -2, respectively. (6, 7). Both HSV-1 and -2 are typically acquired in childhood or early adulthood, primarily through vertical or sexual transmission, and are never cleared. (8) In the immunocompetent population, HSV infection is typically latent …
The diagnosis of mucocutaneous HSV may be made on clinical grounds alone in the majority of cases. Vesicular fluid should be swabbed to confirm the presence of HSV using polymerase chain reaction (PCR) or nucleic acid amplification testing (NAAT), and exclude other alternate or concurrent viral pathogens (including varicella, discussed below) as well as bacterial …
There is no difference in management between HSV-1 and HSV-2 infection. Few randomised, controlled trials have been performed in PLWHIV. Aciclovir, famciclovir and valaciclovir have all been shown to be safe and effective as both intermittent and continuous therapy for HSV-2 clinical and subclinical infection in HIV-positive individuals. (21) In the majority of situations, mucocutaneous …
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 …
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 …
Developing a sustainable HIV, Viral Hepatitis and Sexual Health Workforce
Acknowledgement of Country
We pay our respects to the Aboriginal and Torres Strait Islander peoples of the past, present, and future, including the Gadigal peoples (Sydney office), the Turrbal and Jagera/Yuggera peoples (Brisbane office), and all First Nations people of the nations where we live and work.
ASHM Health | ABN 48 264 545 457 | CFN 17788 | Copyright © 2024 ASHM