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HIV infection is associated with a greater number of skin abnormalities among women as well as men

Men infected with the human immunodeficiency virus (HIV) that causes AIDS commonly have HIV-related skin disease. Apparently skin abnormalities, ranging from unsightly to painful, are also common among women with HIV disease and are more common among women with more advanced disease (fewer CD4 cells or a higher viral load), concludes a new study. The researchers analyzed baseline data from the Women's Interagency HIV Study, a prospective study of the natural history of U.S. women who are infected with HIV or at risk for infection. They included a total of 2,018 HIV-infected women and 557 uninfected women in the analysis.

HIV-infected women were more likely to report skin abnormalities than uninfected women (63 percent vs. 44 percent), and were more likely to be diagnosed with more than two skin problems (6 percent vs. 2 percent). Folliculitis (inflammation of hair follicles), seborrheic dermatitis (chronic skin inflammation characterized by scaling and yellow crusted patches, especially on the scalp), herpes zoster (shingles, a painful reactivation of the chicken pox virus that affects the nerves), and onychomycosis (fungal infection of the nails) were more common among HIV-infected women.

HIV-infected women who had CD4 counts less than 50 or high viral loads (100,000-499,999 and greater than 499,999 copies of virus per ml of blood) were nearly twice or twice as likely to have skin abnormalities (odds ratio, OR 1.68, 1.77, and 2.15, respectively). Other predictors of skin abnormalities included black race (OR 1.38) and injection drug use (OR 2.74).

The viremic state may cause a heightened but nonspecific inflammatory skin response analogous to increased drug eruptions seen with Epstein-Bar virus infection. On the other hand, HIV may have a direct effect on the pathogenesis of Kaposi's sarcoma (skin cancer characterized by bluish-red nodules), which affected women with viral loads greater than 50,000 copies per ml.

For more details, see "Prevalence and predictors of skin disease in the Women's Interagency HIV Study (WIHS)," by Paradi Mirmirani, M.D., Nancy A. Hessol, M.S.P.H., Toby A. Maurer, M.D., and others, in the May 2001 Journal of the American Academy of Dermatology 44, pp. 785-788.

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