Immunosuppressed patients are prone to infections and skin cancers. This chapter covers HIV infection and skin conditions seen in immunocompromised patients.

Human Immunodeficiency Virus Infection

Over 30 million people are infected with HIV and 65% of these are in sub-Saharan Africa. In the UK around 60,000 individuals are affected. There are around 6000 new cases per year with 10% presenting with advanced HIV disease or AIDS (acquired immunodeficiency syndrome).

The HIV virus is transmitted by sexual intercourse, contaminated injections used by drug abusers, blood products, breast milk and by perinatal transmission. This can co-exist with other sexually transmitted infections such as hepatitis C.

HIV is a human retrovirus containing RNA which transcribes DNA via a reverse transcriptase enzyme. HIV infection leads to CD4 cell depletion starting as a primary cell immunity defect progressing to general immune dysfunction. A CD4 count of <200 mm² (normal >500 mm²) is regarded as diagnostic of AIDS. Markers of disease progression include high HIV viral load measured by polymerase chain reaction (PCR) assay. These markers can also be used to monitor response to treatment.

HIV seroconversion (HIV p24 antigen detectable) can occur up to 3 months after infection. Twenty-five per cent develop clinical seroconversion illness consisting of fever, malaise, rash, sore throat, lymphadenopathy and arthralgia. HIV PCR and p24 antigen confirm the diagnosis of HIV and an antibody test (Western blot or immunofluorescence assay) can also be carried out.

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