Hair, Nails and Oral Mucosal Disorders among People Living with Human Immunodeficiency Virus and AIDS in Osogbo and Diagnostic Performance on Low CD4 Cells Count
Journal Title: Journal of Clinical and Diagnostic Research - Year 2017, Vol 11, Issue 11
Abstract
Introduction: The epidemic of HIV/AIDS continues amidst reduce funding in most low and middle-income countries. The need to find low-cost clinical equivalents of the laboratory markers of immunosuppression, therefore become imperative. Aim: To document hair, nails and oral mucosal disorders among People Living with HIV/AIDS (PLWHA) and determine their performance in predicting low CD4 count. Materials and Methods: This cross-sectional study included 315 patients recently diagnosed PLWHA at the HIV clinic of LAUTECH Teaching Hospital, Osogbo, Nigeria. Participants were examined for hair, nails, and oral mucosal disorders and CD4+ cell count was estimated. Sensitivity, specificity, positive and negative likelihood ratio were calculated using online MedCalcR. Results: Mean age of participants was 36.68±10.03 years, and 227 (72.1%) were female. The CD4+cell count below 200 was significantly associated with lower weight, BMI and male gender. The prevalence of integument and oral lesions include blue-black nail pigmentation 17.8%, oral candidiasis 17.5%, fluffy hair 14.9%, lighter colour hair 13.8%, diffuse alopecia 9.2%, oral hyperpigmentation 7.3%, and onychomycosis 5.4%. Disorders significantly associated with median CD4 count <200 cells/mm3 include: blue-black nail pigmentation (p <0.001), fluffy hair (p<0.001), lighter colour hair (p=0.002), oral candidiasis (p=0.004) and aphthous ulcers (p=0.004). Performance of hair, nails and oral disorder in detecting CD4+ cell count <200: Blue nails: sensitivity 92.9%, specificity 64.1%, positive likelihood ratio 2.6, and negative likelihood ratio 0.1; onychomycosis: sensitivity 70.6%, specificity 55.4%, positive likelihood ratio 1.6, and negative likelihood ratio 0.5; fluffy hair: sensitivity 70.2%, specificity 58.2%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; lighter colour hair: sensitivity 74.1%, specificity 56.6%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; Oral candidiasis: sensitivity 78.2%, specificity 60.8%, positive likelihood ratio 2.0, and negative likelihood ratio 0.4. The combinations in twos and threes increased the sensitivity (88.9-100.0%) and negative predictive values (85.7-100%), but specificities are reduced below 50%. Conclusion: Although blue-black nail pigmentation, fluffy hair, lighter colour hair, oral candidiasis are associated with low CD4 count, their presence is not a good diagnostic test to detect CD4 count <200 cells/mm3 , hence cannot replace the CD4 count machine but their absence make the presence of CD4+cells count <200 cells mm3 reliably unlikely.
Authors and Affiliations
Adeolu Oladayo Akinboro, Edward Olugbenga Ayodele, Olaniyi Emmanuel Onayemi
Keywords
Related Articles
- EP ID EP366993
- DOI 10.7860/JCDR/2017/29624.10873
- Views 49
- Downloads 0
Evaluation of Treatment Responses and Failures of Intensive Care Unit Acquired Blood Stream Infections
ABSTRACT Introduction: Blood Stream Infections (BSI) are the second or the third most common infections acquired in Intensive Care Units (ICU) following pulmonary infections. Risk factors likely to affect response to tre...
Prolonged Remission and Good Quality of Life with Maintenance Chemotherapy in Recurrent Ewing’s Sarcoma
ABSTRACT Ewing’s sarcoma is an aggressive tumour of bone commonly affecting individuals in 10-20 years of age group. Older age and metastatic disease has an overall poor outcome. We are reporting a case of a 37-year-old...
Auditory and Visual Reaction Time in Polycystic Ovarian Syndrome
ABSTRACT Introduction: Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder of female reproductive system causing infertility, irregular menstrual cycle and hormonal imbalance characterised by hyperestrogenemia, hyp...
Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Paediatric Caudal Epidural Block: A Randomised Controlled Study
ABSTRACT Introduction: Caudal epidural block is a reliable technique to provide perioperative analgesia for infra-umbilical surgeries in paediatric population. Several adjuvants are used along with local anaesthetics to...
Effect of Mahamantra Chanting on Autonomic and Cognitive Functions-An Interventional Study
Abstract Introduction: Stress is a major health issue which leads to several potential negative health and well-being outcomes. Early interventions like yoga, meditation and music can reduce stress induced morbidity and...