- Nguyen Duy Hung: National Hospital of Dermato-Venereology

1. CLINICAL FEATURES OF SKIN DISEASES AND SEXUALLY TRANSMITTED DISEASES IN PEOPLE LIVING WITH HIV AT THEDERMATO-VENEREOLOGY CENTRE OF HAI PHONG CITY - Nguyen Duy Hung: National Hospital of Dermato-Venereology • Tran Khanh Toan: Hanoi Medical University - Dao Manh Khoa: Dermato-Venereology Centre of Haiphong City Hanoi, 24 - 11 - 2015

2. Outline Background Research objectives Research objects and methods Results & Discussions Conclusions Recommendations

3. 1. Background - Haiphong is a city with the HIV prevalence rate of 0.5 % and is 1 of the 5 provinces/cities with the highest number of people living with HIV (PLHIV) in Vietnam.- Over 2,000 PLHIV with skin diseases and sexually transmitted diseases (STDs) have been treated at the Dermato-Venereology Centre of Haiphong City. - In order to help planners and dermato-venerologists understand the situation and clinical features of skin diseases and STDs in PLHIV, we conduct this research with 2 objectives: 3

4. 2. Research objectives 1. To survey the situation and factors related to skin diseases and STDs in PLHIV treated at the Dermato-Venereology Centre of Haiphong City from July 2008 to April 2011. 2. To describe clinical characteristics of some skin diseases and STDs in HIV/AIDS. 4

5. 3. Research object and methods 3.1. Research objects HIV+ patients with skin diseases and STDs coming to the Dermato-Venereology Centre from July 2008 to April 2011 and having sufficient information on their T-CD4 count. Selection criteria: HIV+ patients with skin diseases and STDs coming to the Dermato-Venereology Centre for medical examination and treatment from July 2008 to April 2011 and already getting T-CD4 count. 5

6. 3. Research object and methods 3.2. Research methods - Research design: Retrospective descriptive cross-sectional research - Sample size:All the 861 HIV+ patients with skin diseases and STDs coming to the Dermato-Venereology Centre for medical examination and treatment from July 2008 to April 2011 and having sufficient information on their T-CD4 count. 6

7. 3. Research object and methods - Criteria for diagnosing skin diseases and STDs:diagnosis is done base on clinical symptoms and tests performed by the Centre. - Criteria for determining HIV status:HIV confirmatory test results from the Provincial AIDS Centre or Viet-Tiep Friendship Hospital (Haiphong City). T-CD4 count is also done by these 2 establishments. - AIDS patients: are those with CD4 count <200 cells/mm3 or any disease(s) of the 4th stage. 7

8. 3. Research object and methods 3.3. Data processing - Data are entered into and processed by SPSS 16.0. - Data are analyzed, synthesized, compared and treated with medical statistic method. 3.4. Research ethics - This is a retrospective study so it does not cause any harm to patients and the community. - All information of patients are kept confidential. - This research is in accordance withthe law and culture of Vietnam. 8

9. 4. Results and discussion 4.1. Situation of skin diseases, STDsand related factors in PLHIV Table 4.1: Situation of skin diseases and STDs(n=861) Phan Van Yen: skin diseases account for 60%

10. Table 4.2: Prevalence of skin diseases in PLHIV

11. 4. Results and discussion Table 4.3. Prevalence of STDs Tran Hau Khang: genital warts account for 79.5%; De Camargo Brasil 1/3 genital wart/STDs. (* 170 is the number of patients having STDs, however some patients have 2 STDs).

12. 4. Results and discussion Table 4.4. Sex and age of the studied patients(n=861) • The difference in male and females’ age groups is statistically significant with p <0.001 • The number of males is 3.2 times higher than that of females. In another study conducted by Pham Van Yen, the figure is 7.6 times higher for males. • The average age is34.3 years old; that in Tran Hau Khang’s study is 32.26 and in Akinboro’s study is 32.72.

13. 4. Results and discussion Table 4.5. Number of CD4 cells in 861 studiedpatients Number of CD4 cells is lower than that in Raju’s study with 80 patients (409,83 mm3) Table 4.6. Association between number of CD4 cells with prurigo AIDS patients are 1.57 times more likely to get prurigo than patients with CD4> 200, P<0,05. Akinboro also concluded that prurigo is closely associated with the number of CD4 cells.

14. 4. Results and discussion Table 4.7. Association between number of CD4 cells with seborrheic dermatitis (SD) The SD rate in patients with CD4 <200 is higher but it is not statistically significant (p> 0.05). Table 4.8. Association between number of CD4 cells with atopic dermatitis (AD) The AD rate in patients with CD4 <200 is lower with statistical significance (p <0.05).

15. 4. Results and discussion Table 4.9. Association between the number of CD4 cells with zona The Zona rate in patients with CD4 <200 is lower with statistical significance (p<0.05). Josephine in Cameroon also concluded that Zona occurs more frequently in the stage of advanced HIV infection. Table 4.10. Association between the number of CD4 cells with oral fungus Finding of this study is different from that of Bravo in Venezuela: oral fungus rate in patients with CD4 <200 is much higher than those with CD4> 200.

16. 4. Results and discussion 2. Clinical features of skin diseases and STDs in PLHIV Table 4.11. Clinical features of seborrheic dermatitis in PLHIV Most lesions in the face can be seen with erythema, desquamation, itching. 32.3% spread to two or more positions

17. 4. Results and discussion Chart 1. Clinical features of scabies in PLHIV Symptom Lesions spreading throughout the body accounts for a high proportion (83.3%). No Norwegian scabies.

18. 4. Results and discussion Table 4.12. Clinical features of zona in PLHIV Pham Van Yen: 84.6% lesions spread to two sides of the body.

19. 4. Results and discussion Table 4.13. Clinical features of oral fungus in PLHIV Most of lesions are white array; 100% are on tongue; 27% are in mouth, cheek, throat. Wen Y in China: only 13.9% lesions are white arrays.

20. 4. Results and discussion Chart 2. Clinical features of syphilis in PLHIV 75% of syphilis in period 2; 25% have giant papules; mucosal lesions unseen.

21. Lesions appear in unusual positions : eyes , nose , breasts , armpits , mouth . Huge size . 4. Results and discussion Table 4.14. Clinical features of condylomata acuminate in PLHIV Lesions appear in unusual positions: eyes, nose, breast, armpit, mouth. Giant size. 21

22. 4. Results and discussion Table 4.15. Other associated opportunistic infections Tuberculosis accounts for 90.5 % among associated opportunistic infections. Need to pay attention to it in health care. 22

23. 5. Conclusions • Situation and factors related to skin diseases and STDs in PLHIV - 81,4% patients have skin diseases, 15,2% have STDs and 3,4%have both. - Skin diseases: prurigo 33,6%, seborrheic dermatitis 10,8%, atopic dermatitis 6,9%, zona 6%, oral thrush 4,3%. - STDs:C. acuminata 11,7%, bacterial vaginosis 2%, herpes 1,2%, vaginal candidiasis0,8%, gonorrhoea 0,4%, syphilis 0,4%. - The ratio of male/female patients is 3.2. - The average age is 34.3 years old. The average number of CD4 cells is low (212.93). - The lower the number of CD4 cells is, the more severe clinical manifestations are. 23

24. 5. Conclusions 2. Clinical features of some skin diseases and STDs • Oral fungus: white arrays account for 89.2%,lesions on tongue account for 100%. - C. acuminata: 20,8% are of giant and big sizes. May appear in unusual positions:eye,nose, mouth, anus,breast and armpit. • Rare diseases: penicilliosis • CD4 testing can help foresee common skin diseases in PLHIV, and vice versa, through clinical signs of skin diseases and STDs, doctors can predict the degree of immunodeficiency in PLHIV. 24

25. SOME IMAGES OF PATIENTS 25

26. SOME IMAGES OF PATIENTS Woman, 34 yrs old: Candidiasis Man, 30 yrs old: penicilliosis

27. SOME IMAGES OF PATIENTS Man, 30 yrs old: Condylomata acuminata in eye Man, 40 yrs old: Condylomata acuminata

28. Thank you so much for your attention!