Epidemiology of Pruritic Papular Eruption and Major Hiv Related Skin Diseases Affecting New Patients in Rift Valley Provincial General Hospital

Abstract

Pruritic papular eruption (PPE) is a skin disease exclusively found in HIV seropositive individuals. It is characterised by eruption of extremely itchy papules, conspicuous blemishes and a profound negative impact on quality of life (QoL). Its prevalence ranges from 6.9% to 58% depending on geographical location. HIV related skin diseases affect up to 98% of HIV seropositive individuals. The epidemiology of PPE and major HIV related skin diseases among adults attending Comprehensive Care Centre (CCC) in Rift Valley Provincial General Hospital (RYPGH) has not been documented. The impact of PPE on QoL as well as the prevalence of major HIV related skin diseases among patients with various CD4 cell counts in RVPGH is also unknown. This study aimed at determining epidemiology of PPE, establishing its impact on QoL and determining the prevalence of major HIV related skin diseases and their relationship with CD4 cell counts. The study was conducted at the CCC in RVPGH in Nakuru County. New HIVseropositive patients aged 18 years and above formed the target population. A cross-sectional studydesign was used to conduct this study. Sample size was determined using Daniel's formula (1999). 394 consecutive patients were studied. Consenting patients underwent a full skin examination conducted by two dermatologists. Patients with PPE were reviewed separately for further epidemiologic evaluation and QoL assessment. Data on QoL was collected using the Dermatology Life Quality Index (DLQI). Epidemiologic questionnaires and observational checklists were used to collect data on major HIV related skin diseases and CD4 cell counts. Descriptive statistics were used to describe qualitative data. Chi-square and logistic regression were used to evaluate associations. Student's t test was used to evaluate differences in means. A p-value < 0.05 was considered significant. The prevalence of PPE in this study was 5%. PPE affected more women (75%) than men. The mean DLQI score for QoL was 15.2. Prevalence of HIY related skin diseases was 42.1 %. There was a significant association between PPE, oral candidiasis, seborrheic dermatitis and low CD4 cell counts. The burden of PPE and major HIVrelated skin disease in RVPGH is substantial and significantly associated with low CD4 cell counts. Clinicians in RVPGH need to be updated on the burden and impact ofPPE and the major HIY related skin diseases for proper and holistic management. More skin specialists are needed to cope with increased demand for care occasioned by patients with HIV related skin disease in RYPG