HIV related skin diseases and sexually transmitted infections in Africa

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Skin symptoms and signs occur during the course of HIV infection in about 90% of those infected. They are frequently the initial indication of immunodeficiency and, later in the course of the disease, may refl ect the immunological status of the patient. Both infectious and non-infectious skin diseases are common. Infections may be caused by viruses like Varicella-zoster virus or Human herpesvirus-8, but also by bacteria, fungi, protozoa and ectoparasites. An infection that persists or reoccurs despite otherwise eff ective treatment or a skin disease that is atypical, more extensive and aggressive than usually observed must raise the suspicion of HIV infection. Antiretroviral treatment (ART) is the corner stone in the management of patients with HIV infection. However, ART is not always available, may not be aff ordable, or cannot be used because of side eff ects. If ART is effective, the immune function may be restored and many skin diseases improve. Failure of skin diseases to improve during ART, e.g. Kaposi’s sarcoma, may be an indication of lack of compliance or HIV resistance. This guide provides the health worker with a brief discussion and high quality pictures of the most common dermatoses in pigmented skin and their management in resource limited settings. Sexually transmitted Infections are discussed according to the syndromic case management as advocated by the World Health Organisation. We advice to use existing national STI treatment regimen. However, we provide STI treatment regimen that are based on international recognized guidelines. This illustrated guide will improve the care of individuals with HIV infection throughout Africa for allowing us to make use of some and will allow appropriate allocation of scarce resources in health care. We would like to thank the Regional Dermatology Training Centre, Moshi, Tanzania; Department of Dermatology, University Medical Centre, Utrecht, Netherlands; Department of Infectious Diseases, Dar es Salaam, Tanzania; City Health Services, Bulawayo, Zimbabwe; Department of Dermatology, Stellenbosch University, South Africa and Professor Ben Naafs for allowing us to make use of some of their illustrations.

Merja Kousa M.D.
University Lecturer in
Dermatology and Venereology,
Helsinki University, Finland

Cornelus Sanders M.D.
Chief Clinical Department,
Department of Dermatology,
University Medical Center,
Utrecht, Netherlands

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This article contains material which may portray an identifiable person who is alive or deceased recently. The use of images of living or recently deceased individuals is, in some jurisdictions, restricted by laws pertaining to personality rights, independent from their copyright status. The authors are solely responsible for ensuring that they do not infringe someone else's personality rights. © Merja Kousa and Cornelus Sanders Kopijyvä Oy, Jyväskylä 2006 ISBN-952920163X

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