In Australia approximately 500 new cases of AIDS are diagnosed each year. The incidence of new AIDS cases has actually leveled off over the last three years, and this is probably related to widespread education about safe sex, needle exchange programmes and the fact that blood products are now routinely screened for the HIV virus, which is responsible for the disease. (This is not the case, however, in other parts of the world.) The survival rate among AIDS sufferers has also dramatically improved over the last few years, especially with the introduction of new anti-viral drugs such as Azidothymidine (AZT).
AIDS damages the body’s immune system, leaving sufferers open to severe opportunistic infections such as viral, bacterial and fungal infections, as well as certain cancers. The skin is a very important organ in the manifestation of AIDS, and a dermatologist may be the first one to make the diagnosis.
Seborrhoeic dermatitis can be one of the first signs of AIDS. In AIDS sufferers the condition is often severe and is resistant to normal therapeutic creams. Psoriasis can also be a manifestation of AIDS. Again, this condition is often unresponsive to the usual healing creams. Other treatments can interfere with the immune system and so may worsen AIDS. On the other hand, psoriasis in those with AIDS often responds well to the new anti-AIDS drugs such as AZT.
Skin infections due to viruses and fungi are also very common in AIDS sufferers. Warts and molluscum contagiousum occur frequently and extensively, causing major cosmetic problems. These conditions are also resistant to normal treatments. Likewise, herpes infections tend to occur more severely, with extensive ulceration. Fortunately, these infections often respond well to anti-viral drugs such as Acyclovir (Zovirax) or foscarnet. Shingles, which is also caused by the herpes virus, can be severe and extremely painful in those with AIDS, and must be treated with high doses of Acyclovir.
Fungal infections such as tinea and thrush also readily occur. Persistent tinea of the face and groin are often resistant to conventional forms of therapy, as is thrush of the mouth.
Skin cancers tend to be more prevalent and more aggressive in AIDS sufferers. As most sufferers are under fifty, however, skin cancer is not a major cause of morbidity. Kaposi sarcoma, a cancer of the blood vessels, is a particular feature of AIDS. It can produce many bruise-like lesions on the skin so that surgical removal is rarely a practical therapeutic option, and chemotherapy is often necessary.