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Nail Changes in Patients Infected With Human Immunodeficiency Virus
A Prospective Controlled Study
Bernard Cribier, MD, PhD;
Marcello Leiva Mena, MD;
David Rey, MD;
Maria Partisani, MD;
Vincent Fabien;
Jean-Marie Lang, MD;
Edouard Grosshans, MD
Arch Dermatol. 1998;134:1216-1220.
Objectives To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)–infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects.
Design Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed.
Setting Primary care university hospital.
Patients A total of 155 HIV-1–positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio.
Intervention None.
Main Outcome Measure Clinical examination findings.
Results Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P<<.001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P<.05), transverse lines (7.1%) (P<.01), onychoschizia (7.1%) (P<.05), leukonychia (14.3%) (P<.001), and longitudinal melanonychia (14.8%) (P<.01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P<.001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients.
Conclusion Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.
From the Dermatology Department (Drs Cribier, Leiva Mena, and Grosshans), HIV Care Centre (Drs Rey, Partisani, and Lang), and Epidemiology Department of Dentistry School (Mr Fabien), University Hospital, Strasbourg, France.
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