More than 90% of people living with HIV, if their HIV is untreated, experience one or more skin conditions during the course of their infection. 21 This means that dermatovenereologists can play a vital role in diagnosing previously undiagnosed HIV infection.
In some cases, pre-existing conditions such as seborrheic dermatitis or psoriasis are exacerbated as HIV lowers the CD4 count and affects the immune response, while in others the skin problems are of new onset. Some conditions, such as Kaposi’s sarcoma, strongly indicate the presence of HIV.
You can and should offer HIV testing to patients presenting with HIV indicator conditions. When the condition is AIDS-defining (see details of each condition on the following pages), offering an HIV test is especially critical. For other indicator conditions, an HIV test offer should be routine.
Certain more common conditions may indicate underlying HIV infection; it is important to offer a test if:
You should carefully assess the medical history to determine whether the patient has experienced other symptoms or been treated elsewhere for conditions that suggest immunodeficiency, raising the index of suspicion for HIV. Asking the patient about their sexual and drug use history may reveal risk factors for HIV infection.
You should also offer testing when the management of an individual’s condition could be adversely affected by the presence of HIV infection, regardless of whether the condition is HIV-associated, for example when using immunosuppressive drugs.
The next pages contain details and guidance on each HIV indicator condition with which patients may present to dermatovenereologists. It is divided into: