To Seek the Hidden Monster

Problem statement: The asymptomatic stage of HIV infection is dealt with in detail in all Dermatology books. Patients in this stage present with skin lesions that occur even in the immunocompetent. However when these lesions recur, are atypical, aggressive or unresponsive to treatment, it is worthwhile to go back into the history to ascertain if there is a history of high risk behavior. Approach: To identify patients in the asymptomatic stage of retroviral infection, from benign looking skin lesions and to create a scheme for index of suspicion for HIV infection. To evolve a protocol for the management of such patients. This is an ongoing study for the past 1 years. We have studied 125 patients whom we thought to be in the asymptomatic phase of retroviral infection. The cutaneous markers we looked for included seborrheic dermatitis, verrucous warts, pruritic papular eruptions, extensive dermatophyte infection, tinea versicolor and impetigo. Results: Certain skin diseases were found to be more prevalent than certain others and so was the combination of these skin diseases, along with the prevalence in various age groups. About 118 of our patients had a history of high risk behavior as the only link between retroviral infection and its skin manifestations. The statistical relevance and a protocol for management and social implications were worked out in detail. Conclusion/Recommendations: Recognizing the asymptomatic stage of retroviral infection, we think may contribute to its control in the society and also improve the quality of life in the infected persons. We reiterate to look out for the skin lesions per se or in combinations and to elicit high risk behavior in an empathetic, non judgmental and non moralistic way. To consider the link between HIV infection and HRB. An excellent opportunity to identify patients with HRB. Possible that they are HIV positive, hence counsel them.