Skin conditions in persons living with HIV during hospital admission in the UK

TL;DR

This study examines skin conditions in people living with HIV in the UK and finds that skin infections, especially bacterial cellulitis, are most common during hospital admissions.

Contribution

The study provides a detailed characterization of skin disease profiles in a UK-based population of people living with HIV.

Findings

Skin infections were the most common category of skin problems in hospitalized people living with HIV.

Bacterial cellulitis was the most frequent dermatological condition overall.

Oral candidiasis was the most common condition among those with advanced HIV infection.

Abstract

The range of skin disease associated with advanced HIV infection is well described. Effective antiretroviral therapy has modified the spectrum of skin disease associated with HIV infection.

To characterize the profile of skin conditions occurring in a UK population of people living with HIV (PLHIV) during admission to a tertiary hospital.

A retrospective review of inpatient admission records was conducted for all patients admitted to a tertiary hospital between January 2018 and December 2022. Data were collected using a standardized data extraction form and analysed with Microsoft Excel using descriptive statistics.

We identified 199 patients [median age 53 years; interquartile range (IQR) 41.5–63.0]. The median duration of HIV infection was 12.75 years (IQR 6.10–19.58), with a median duration on antiretroviral therapy of 8 years (IQR 0–14) and a median CD4 count of 368 (IQR 90–656) on admission. In total, 303 cases of skin disease were identified; the majority were skin infections (n = 164; 54.1%), followed by inflammatory dermatoses (n = 53; 17.5%), skin tumours (n = 39; 12.9%) and drug reactions (n = 13; 4.3%). In 11.2% of cases (n = 34), the diagnosis was unknown. Of the primary skin infections seen, 45.7% (n = 75/164) were bacterial, 26.8% (n = 44/164) were viral, 22.0% (n = 36/164) were fungal and 2.4% (n = 4/164) were parasitic. The most common condition was cellulitis, which occurred in 45 patients (22.6%). Sixty patients (30.2%) presented with advanced HIV infection (CD4 <200 cells mm–3). The most common conditions in this group were oral candidiasis (n = 21; 35%), herpes simplex virus infection (n = 12; 20%), seborrhoeic dermatitis (n = 9; 15%) and Kaposi sarcoma (n = 9; 15%).

Cutaneous infection was the most common category of skin problem in this population of PLHIV during hospital admission. Bacterial cellulitis was the most common dermatological condition overall, while oral candidiasis was the most common condition in those with advanced HIV infection. Further work is needed to better characterize the profile of skin disease in PLHIV, including in larger prospective cohorts and outpatient settings.

Effective antiretroviral therapy has modified the skin manifestations of HIV. The aim of this study was to characterize the profile of skin disease in a UK-based population of people living with HIV (PLHIV). Of the 306 skin conditions identified, the majority were skin infections (54.6%), followed by inflammatory dermatoses (17.3%), skin tumours (12.7%) and drug reactions (4.2%). Cutaneous infection was the most common skin problem in this population of PLHIV during hospital admission. Bacterial cellulitis was the most common dermatological condition overall, whilst oral candidiasis was the most common condition in those with advanced HIV. Further work is needed to characterize the profile of skin disease in a larger population of PLHIV, including in an outpatient setting.

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