The term “AIDS lesions” is an umbrella term for a wide range of dermatological issues that arise from a severely weakened immune system caused by Acquired Immunodeficiency Syndrome (AIDS). These skin manifestations are often one of the first visible signs of the disease’s progression. These conditions are not exclusive to individuals with HIV/AIDS but can also occur in other contexts of immunosuppression. The appearance of these lesions can be an indicator of underlying immune status.
The skin’s health is closely tied to the immune system’s functionality. When the immune system is compromised, it becomes less capable of fighting off germs and controlling cellular growth. This leads to various skin problems, ranging from infections caused by bacteria, fungi, and viruses to certain types of cancers.
The Underlying Cause of Lesions in AIDS
The development of skin lesions in individuals with AIDS is a direct consequence of the damage HIV inflicts upon the immune system. HIV targets and destroys a type of white blood cell known as the CD4 T-lymphocyte, or T4 cell. These cells are responsible for coordinating the body’s immune response against pathogens.
As HIV multiplies, it reduces the number of CD4 cells in the body. AIDS is the most advanced stage of HIV infection, diagnosed when a person’s CD4 cell count drops below 200 cells per cubic millimeter of blood (cells/mm³). A healthy CD4 count ranges from 500 to 1,500 cells/mm³.
This state of severe immunodeficiency means the body cannot effectively defend itself against opportunistic infections. These are infections caused by germs that a healthy immune system would normally control. Many of these opportunistic infections and certain cancers manifest as lesions on the skin or mucous membranes.
Types of AIDS-Related Lesions and Their Appearance
The skin manifestations associated with AIDS are varied, reflecting the wide range of opportunistic pathogens and conditions that can arise from a compromised immune system. Their appearance provides clues to the underlying cause, but a definitive diagnosis requires medical evaluation.
Kaposi Sarcoma (KS)
Kaposi Sarcoma (KS) is a cancer that affects the cells lining blood and lymphatic vessels. It appears as dark, painless lesions on the skin which can be brown, purple, or red. These lesions can be flat patches or raised nodules. Common locations include the feet, legs, face, and genitals, and on darker skin, the lesions may look dark brown or black. KS can also develop inside the mouth, in lymph nodes, and in internal organs like the lungs and digestive tract, where it can cause more serious symptoms.
Viral Infections
Several viral infections can cause skin lesions in people with advanced HIV. Molluscum contagiosum appears as small, firm, flesh-colored or pink bumps with a central dimple; in people with AIDS, outbreaks can be extensive. The Herpes Simplex Virus (HSV) can cause recurrent outbreaks of painful sores or blisters around the mouth, genitals, or anus. The Epstein-Barr virus can cause Oral Hairy Leukoplakia, which presents as white, “hairy” patches on the sides of the tongue that cannot be scraped off.
Fungal and Bacterial Infections
Fungal infections are common. Oral Candidiasis, or thrush, results in creamy white, slightly raised patches in the mouth, often on the tongue or inner cheeks, which can be painful and may bleed when scraped. A bacterial infection known as Bacillary Angiomatosis (BA) can cause skin lesions that look similar to Kaposi Sarcoma. BA presents as red or purple bumps or nodules that can appear anywhere on the body, may bleed easily, and is treatable with antibiotics.
Diagnosis and Medical Evaluation
Identifying the cause of a skin lesion in a person with HIV involves a physical examination and a detailed patient history. A healthcare provider will note the size, shape, color, and location of the lesions. The patient’s history includes their known HIV status, recent CD4 count, and current medications.
Because different conditions can present with similar appearances, a visual inspection alone is not sufficient for a definitive diagnosis. A reliable method for distinguishing between conditions is a skin biopsy. This procedure involves taking a small sample of the affected tissue for laboratory examination under a microscope.
In the lab, special stains can identify specific pathogens or cellular changes. For example, staining can detect Human Herpesvirus-8 (HHV-8) to confirm Kaposi sarcoma. Blood tests are also performed to measure the HIV viral load and CD4 T-cell count, which gives a picture of the patient’s immune function and helps guide treatment.
Management and Treatment Approaches
Managing AIDS-related lesions involves treating the underlying HIV infection with Antiretroviral Therapy (ART). ART is a combination of medicines that combat HIV by preventing the virus from replicating, which reduces the viral load. This allows the immune system to recover and the number of CD4 cells to increase.
As the immune system strengthens with ART, it becomes capable of controlling the opportunistic infections or cancers that cause skin lesions. Many conditions, like Kaposi sarcoma, may improve or resolve with ART alone, without requiring direct treatment. The introduction of antiretroviral therapy has decreased the incidence of Kaposi sarcoma.
While ART is the primary approach, some lesions may require specific, localized treatment if they are severe or cause discomfort. For severe cases of Kaposi Sarcoma, treatments may include chemotherapy, radiation therapy, or cryotherapy. Viral infections like herpes are treated with antiviral medications, fungal infections like thrush with antifungal drugs, and bacterial infections such as Bacillary Angiomatosis respond to antibiotics.