Skin Disease in HIV-Positive Persons Living in Puerto Rico

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Abstract
OBJECTIVES: To determine the frequency of skin disease in persons infected with the human immunodeficiency virus (HIV), to validate the agreement of self-reported skin condition(s) versus objective data obtained by physical examination, and to describe the characteristics of HIV-positive persons with skin disease in Puerto Rico. DESIGN: Descriptive correlational design. SETTING AND PARTICIPANTS: Ninety-five HIV-positive adults in San Juan, Puerto Rico. Ninety-five adults who were HIV-positive participated. RESULTS: Ninety (94.7%) participants had skin disease and/or signs or symptoms suggestive of disease. Diseases most often reported were onychomycosis (n = 16; 17.8%) and nongenital warts (n = 11; 12.2%). Signs and symptoms reported were dryness (n = 59; 65.6%), itch (n = 58; 64.4%), erythema (n = 30; 33.3%), induration (n = 13; 14.4%), postinflammatory hyperpigmentation (n = 9; 10.0%), and excoriation (n = 9; 10.0%). Kappa index confirmed the relationship between self-reported skin condition or signs and symptoms and the diagnosis of a skin disease by the physician (k = .42). Positive predictive value was 97.7% (95% confidence interval [CI], 94.7%-100%). Condyloma acuminata was associated with male gender (χ2 = 4.09, P = .043). Tinea pedis (P = .0215), excoriations (P = .002), and prurigo nodularis (P = .0096) were associated with having a low CD4 cell count. CONCLUSIONS: This study shows that persons infected with HIV can identify significant skin manifestations that are associated with the diagnosis of a skin disease. This validates the use of self-reporting of skin conditions in these patients and points to the importance of educating patients and providers to report patient skin problems. Although the high prevalence of skin disease found in this study population supports a need for improving dermatologic care in HIV-infected patients, the findings of such prevalent cutaneous disease can also provide caretakers with ample evidence to suspect and, therefore, test for HIV infection.