Neoplastic Diseases in HIV Patients with Darker Skin

00:01 Moving on to neoplastic diseases in HIV patients.

00:05 The one that we see most commonly is Kaposi's sarcoma, and this presents with patches and plaques on the body as well as the mucosa.

00:14 It is good to always ask the patient to open the mouth so that you can look for involvement of the palate.

00:21 You may see patches and plaques there, and that's typical of Kaposi's sarcoma.

00:27 This is a patient with nodules and ulcerated plaques of Kaposi's sarcoma. Kaposi's sarcoma can also get bacterial secondary infection, as you can see in this picture.

00:43 One may also see Kaposi's sarcoma with other viral infections.

00:47 As I mentioned to you, patients with HIV AIDS may present with multiple skin conditions.

00:53 Here you can see an ulcerated nodule of Kaposi's sarcoma and the plaque on the arm, together with an umbilicated lesion of molluscum contagiosum. A patient diagnosed with Kaposi sarcoma should be referred to an oncologist for further evaluation and co-management. This usually happens after histological confirmation. The patient may need further investigation for systemic involvement, as lungs and the liver and other organs may be involved in patients with Kaposi's sarcoma.

01:30 The other malignancy that we see also in patients with HIV AIDS are non-Hodgkin's lymphoma and Hodgkin's lymphoma.

01:38 In fact, the patient on the left with the breast lesions.

01:41 When we saw this lady, she had just delivered a baby and we thought that she had TB mastitis, and only to find that the patient had lymphoma and the patient was HIV positive.

01:56 So we do get sometimes, you know, confused in terms of what the patients are presenting with.

02:03 And we have to think hard and do all these investigations to try and get the correct diagnosis. Now let's talk about the immune reconstitution inflammatory syndrome, what we refer to as IRIS.

02:18 What is IRIS? It is a state of hyperinflammatory response that usually occurs in the first six months of treatment of HIV AIDS patients. There are three essential criteria for making a diagnosis of IRIS. One, new or worsening infections or inflammatory symptoms. Two, a more than one log decrease in viral load.

02:43 Three, the absence of three other explanations.

02:46 That is, could this be newly acquired infection predict as a predicted cause of previously diagnosed infection or an adverse drug reaction? There are some conditions that can present with IRIS, for example viral infections and sometimes malignancies.

03:06 Some inflammatory conditions can also present as IRIS.

03:13 So in conclusion, skin conditions and early warning sign of HIV and AIDS. And they increase in frequency as HIV advances.

03:24 They tend to occur in unusual anatomical sites with unique clinical appearance and tend to be severe and respond very poorly to conventional treatment.

03:37 The introduction of heart has reduced the prevalence of mucocutaneous disorders and improved the quality of life of patients with HIV AIDS. IRIS and adverse drug reactions are the new manifestations that we encounter more commonly nowadays, and it's always important to look out for those.