STUDY

Prevalence of Cutaneous Disorders in a Population

of HIV-Infected Patients
Southwestern France, 1996
Rosemary Spira, MD; Mélissa Mignard, MD; Marie-Sylvie Doutre, MD, PhD; Philippe Morlat, MD, PhD;
François Dabis, MD, PhD; for the Groupe d’Epidémiologie Clinique du SIDA en Aquitaine

Objectives: To estimate the current extent of cutane-
ous disorders in a large population of ambulatory and
hospitalized human immunodeficiency virus (HIV)–
infected patients and to describe characteristics associ-
ated with the presence of current skin manifestations.
Design: Cross-sectional survey.
Setting: Hospital units participating in the hospital-
based information system of the Groupe d’Epidémiologie
Clinique du SIDA en Aquitaine, southwestern France.
Patients: All the patients seen by physicians between No-
vember 18 and December 20, 1996, in the participating
units (hospital ward, outpatient clinic, or day hospital).
Main Outcome Measures: Prevalence and cumula-
tive incidence of cutaneous disorders.
disease were enrolled; 65.3% had at least 1 skin mani-
festation during the course of HIV infection. A history
of skin disorder was reported for 269 patients (59.8%),
and 199 patients (44.2%) had clinical dermatologic mani-
festations at the time of the study. The most frequent
causes of cutaneous disorders were infections (fungal, vi-
ral, and bacterial), neoplasia, and miscellaneous disor-
ders. Skin diseases were more likely to be reported in ho-
mosexual and bisexual men and in patients with clinically
and biologically advanced HIV infection.
Conclusions: Cutaneous disorders occur more fre-
quently as HIV infection advances and immune func-
tion deteriorates; however, they are common and of vari-
ous types throughout the course of HIV disease. Taking
cutaneous disorders into consideration for case manage-
ment is essential to improve quality of life for HIV-
infected patients.

Results: Four hundred fifty patients at all stages of HIV Arch Dermatol. 1998;134:1208-1212

From INSERM Unit 330,
Université Victor Segalen
Bordeaux 2 (Drs Spira and
Dabis), and the Departments of
Dermatology (Drs Mignard and
Doutre) and Internal Medicine
(Dr Morlat), Bordeaux
University Hospital, Bordeaux,
France. Participants in the
Groupe d’Epidémiologie
Clinique du SIDA en Aquitaine
are listed in the
Acknowledgment section at the
end of the article.
S
KIN DISORDERS are common
manifestations of human im-
munodeficiency virus (HIV)
disease: they affect between
80% and 95% of HIV-infected
patients according to the literature,1-5 oc-
curring at anytime in the course of infec-
tion. Skin is often the first and only organ
affected during most of the course of HIV
disease.1,6,7
For editorial comment
see page 1290
Cutaneous disorders during HIV in-
fection are numerous.4-9 Some have drawn
attention because their onset defines some
of the Centers for Disease Control and Pre-
vention (CDC) acquired immunodefi-
ciency syndrome (AIDS) clinical catego-
ries, eg, oral candidiasis, zoster, herpes
simplex, oral hairy leukoplakia, and Ka-
posi sarcoma,10 but most have been docu-
mented solely in case reports. In the con-
text of HIV infection, cutaneous disorders
can present with particular clinical mani-
festations: unusual anatomical sites, in-
creased severity, treatment failure, and un-
usual clinical appearance.11 Moreover, it
is argued that some cutaneous disorders
reflect the progression of HIV disease,4-6
but this relation is still controversial.2,9
This survey estimated the preva-
lence of cutaneous disorders in a large
population of HIV-infected patients seen
in public hospitals in the Aquitaine re-
gion, southwestern France, and we stud-
ied the link of these skin manifestations
with the progression of HIV disease.
RESULTS
SAMPLE CHARACTERISTICS
Four hundred eighty-eight patients were
seen in the participating hospital units dur-
ing the study, among whom 38 were ex-
cluded from the analysis because of a lack

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PATIENTS, MATERIALS,
AND METHODS
The Groupe d’Epidémiologie Clinique du SIDA en
Aquitaine (GECSA) is a coordinated group of clini-
cians, biologists, and epidemiologists who, since 1987,
have developed a hospital-based information sys-
tem on HIV infection including most of the hospi-
tals of the Aquitaine region.12,13 It is an open system
in which all patients with HIV infection seen in par-
ticipating hospital units are enrolled, if they wish to
do so, and then are followed up prospectively. At each
hospital visit, epidemiological, clinical, biologic, and
therapeutic data are collected on a standardized ques-
tionnaire. Entry criteria for the GECSA system are
HIV-1 infection confirmed by a Western blot test, age
older than 13 years, and informed consent; all types
of HIV transmission categories and the 2 sexes are
included.
All patients seen in hospital units (hospital ward,
day hospital, or outpatient clinic) participating in the
GECSA system, mainly infectious diseases and in-
ternal medicine departments, between November 18
and December 20, 1996, were eligible for this cross-
sectional study. During the study, participating phy-
sicians (17 specialists in dermatology, internal medi-
cine, infectious diseases, and general practice) were
asked to perform a systematic, complete cutaneous
examination of all HIV-infected patients in addition
to the current clinical examination. Moreover, they
were asked to search for a previous history of cuta-
neous disorders in patients’ medical records. A spe-
cific questionnaire about previous and current cuta-
neous disorders was filled in by physicians as they
were examining the patients, as was the standard-
ized GECSA questionnaire providing information
about patients’ baseline characteristics (age, sex, and
HIV transmission group), HIV disease progression
(clinical CDC category and CD4 cell count at the time
of the study), and CDC-classifying cutaneous disor-
ders. Patients for whom no CD4 cell count was avail-
able in the database during the month preceding the
hospital visit were excluded. For patients who were
seen more than once during the study, only the first
visit was taken into account.
Information on history of CDC-classifying cu-
taneous disorders was available in the 2 sources of
information (survey questionnaire and GECSA da-
tabase). To take into account both sources and to avoid
double counting, the cumulative incidence of these
clinical manifestations was estimated by the capture-
recapture method.14,15 Determinants of skin dis-
eases prevalent at the time of the survey were stud-
ied by univariate analysis using x2 and Fisher exact
tests when appropriate.
of a CD4 cell count. The 450 enrolled patients were pre-
dominantly males (71.1%), and their mean age was 38.9
years. Main transmission groups were represented by ho-
mosexual and bisexual men (35.3%), intravenous drug
users (27.8%), and heterosexuals (24.4%). Clinical and
biologic characteristics of patients and their antiretrovi-
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Table 1. Clinical and Biologic Characteristics of
450 Patients Enrolled in the Skin Disorders Survey,
Groupe d’Epidémiologie Clinique du SIDA en Aquitaine,
November to December 1996*
Baseline Characteristic Patients, No. (%)
CDC clinical category
A 145 (32.2)
B 182 (40.4)
C 123 (27.3)
CD4 cell count, 3109/L
0-0.049 35 (7.8)
0.050-0.199 125 (27.8)
0.200-0.349 131 (29.1)
$0.350 159 (35.3)
Antiretroviral drug therapy
None 53 (11.8)
Monotherapy 18 (4.0)
Bitherapy† 189 (42.0)
Tritherapy‡ 183 (40.7)
Others 7 (1.5)
*CDC indicates Centers for Disease Control and Prevention.
†Bitherapy includes 2 nucleoside analogs.
‡Tritherapy includes 1 protease inhibitor and 2 nucleoside analogs.
ral drug treatments at the time of the study are shown in
Table 1. According to the CDC 1993 clinical classifi-
cation, 145 patients (32.2%) were asymptomatic (cat-
egory A), 182 patients (40.4%) had non–AIDS-defining
symptoms (category B), and 123 patients (27.3%) had
full-blown AIDS (category C). Median CD4 cell count
in the month preceding the study was 0.273 3 109/L (273/
mm3) (range, 0.002-1.103 3 109/L); 35.6% of patients had
a CD4 cell count below 0.200 3 109/L. More than 80%
of patients were prescribed either bitherapy with 2 nucleo-
side analogs or tritherapy with 1 protease inhibitor and
2 nucleoside analogs at the time of the survey. Among
the 183 patients undergoing triple combination therapy,
29 (16%) were prescribed a protease inhibitor for the first
time at the time of the study; for the others, the median
time of treatment with a protease inhibitor was 4 months
(range, 0.5-9.0 months). Of these 183 patients receiv-
ing a protease inhibitor, 43.7% had full-blown AIDS and
61.2% had a CD4 cell count below 0.200 3 109/L vs 16.8%
and 19.1%, respectively, among those receiving mono-
therapy or bitherapy. Among the 450 patients in the
sample, 271 (60.2%) were seen in a day hospital, 165
(36.7%) were seen in an outpatient clinic, and 14 (3.1%)
were seen in a hospital ward.
CUMULATIVE INCIDENCE AND PREVALENCE
OF CUTANEOUS DISORDERS
The existence of at least 1 cutaneous disorder during the
course of HIV infection was reported for 294 patients
(65.3%).
Two hundred sixty-nine patients (59.8%) had a his-
tory of at least 1 cutaneous disorder. These 29 previous
cutaneous disorders are described in Table 2. The most
frequent were caused by fungal infections (oral candi-
diasis, which had occurred in almost half of the pa-
tients), viral infections (zoster, herpes simplex, and oral
 Table 2. History (Cumulative Incidence) Table 3. Prevalence of Cutaneous Disorders in 450
of Cutaneous Disorders in 450 HIV-Infected Patients, HIV-Infected Patients, Groupe d’Epidémiologie Clinique
Groupe d’Epidémiologie Clinique du SIDA en Aquitaine, du SIDA en Aquitaine, November to December 1996*
November to December 1996*
Median CD4
Cutaneous Disorder Patients, No. (%) 95% CI† Cutaneous Disorder Patients, No. (%) Cell Count, 3109/L
Oral candidiasis 201 (44.7) 42.2-47.1 Xerosis 44 (9.8) 0.173
Zoster 121 (26.9) 24.0-29.8 Seborrheic dermatitis 41 (9.1) 0.243
Herpes simplex 110 (24.4) 18.9-30.0 Kaposi sarcoma 35 (7.8) 0.124
Seborrheic dermatitis 63 (14.0) ... Pruritus 32 (7.1) 0.180
Oral hairy leukoplakia 47 (10.4) 8.7-12.2 Oral candidiasis 19 (4.2) 0.079
Xerosis 47 (10.4) ... Molluscum contagiosum 17 (3.8) 0.136
Kaposi sarcoma 41 (9.1) 9.1-9.1 Common warts 15 (3.3) 0.224
Pruritus 39 (8.7) ... Folliculitis 15 (3.3) 0.455
Folliculitis 33 (7.3) ... Herpes simplex 13 (2.9) 0.299
Condyloma acuminatum 27 (6.0) ... Eczema 11 (2.4) 0.170
Molluscum contagiosum 23 (5.1) ... Condyloma acuminatum 9 (2.0) 0.298
Common warts 23 (5.1) ... Onychomycosis 7 (1.6) 0.211
Eczema 22 (4.9) ... Dermatophyte infection 6 (1.3) 0.316
Dermatophyte infection 16 (3.6) ... Oral hairy leukoplakia 6 (1.3) 0.173
Drug eruption 13 (2.9) ... Psoriasis 4 (0.9) 0.176
Photodermatitis 11 (2.4) ... Oral ulcers 4 (0.9) 0.130
Oral ulcers 9 (2.0) ... Ecthyma 4 (0.9) 0.311
Onychomycosis 8 (1.8) ... Zoster 3 (0.7) 0.301
Psoriasis 8 (1.8) ... Mycobacteria infection 2 (0.4) 0.041
Ecthyma 6 (1.3) ... Drug eruption 2 (0.4) 0.203
Mycobacteria infection 6 (1.3) ... Pityriasis versicolor 1 (0.2) 0.246
Syphilis 6 (1.3) ... Photodermatitis 1 (0.2) 0.221
Pityriasis versicolor 5 (1.1) ... Porphyria cutanea tarda 1 (0.2) 0.012
Porphyria cutanea tarda 3 (0.7) ... Lichen planus 1 (0.2) 0.233
Primary HIV infection 3 (0.7) ... Hypertrichosis of eyelashes 1 (0.2) 0.168
Vasculitis 2 (0.4) ... Primary HIV infection 1 (0.2) 0.670
Scabies 2 (0.4) ...
Mycosis 1 (0.2) ... *Patients may have more than 1 diagnosis. HIV indicates human
Cytomegalovirus infection 1 (0.2) ... immunodeficiency virus.

*Patients may have a history of several cutaneous disorders. HIV indicates

human immunodeficiency virus; CI, confidence interval.
†For disorders defining a clinical stage in the Centers for Disease Control
and Prevention classification, cumulative incidences were estimated by using
the capture-recapture method with 2 sources of information, and 95% CIs of
these estimates are reported.
hairy leukoplakia), and miscellaneous disorders (sebor-
rheic dermatitis and pruritus).
At the time of the study, 199 patients (44.2%) had
clinical manifestations of skin disease. Among them,
60.8% had 1 dermatologic manifestation, 21.6% had 2
different disorders, 12.6% had 3 disorders, and 5.0% had
4 to 6 different cutaneous signs or symptoms. Patients
with full-blown AIDS were more likely to have more than
1 cutaneous disorder at the time of the study than were
other patients (49.4% vs 32.5%; P=.02).
The prevalence of each cutaneous disorder at the time
of the study is presented in Table 3. Twenty-six disor-
ders were observed among the 199 symptomatic
patients. The most frequent disorders were caused by
neoplasia (Kaposi sarcoma), fungal infections (oral can-
didiasis), viral infections (molluscum contagiosum, com-
mon warts, and herpes simplex), bacterial infections (fol-
liculitis), and miscellaneous disorders (xerosis, seborrheic
dermatitis, pruritus, and eczema). Of the 2 reported drug
eruptions, 1 was caused by co-trimoxazole therapy and
the other was caused by administration of a protease in-
hibitor, indinavir (Crixivan). The median CD4 cell count
of patients with 1 of the 10 more frequent cutaneous dis-
orders ranged from 0.079 3 109/L for oral candidiasis to
0.455 3 109/L for folliculitis.
When analysis was restricted to the specific sub-
group of 154 patients who had begun treatment with a
protease inhibitor before the date of the study, the most
frequent prevalent cutaneous disorders were xerosis
(16%), Kaposi sarcoma (13%), seborrheic dermatitis
(13%), and pruritus (11%). The other skin diseases were
observed in less than 10% of patients of this subgroup.
CLINICAL AND BIOLOGIC DETERMINANTS
OF CUTANEOUS DISORDERS
(KAPOSI SARCOMA EXCLUDED)
Altogether, prevalence and cumulative incidence of cuta-
neous disorders were higher in homosexual and bisexual
patients than in the other transmission groups: 78.5% of
homosexual and bisexual patients reported at least 1 cu-
taneous disorder during the evolution of HIV infection vs
64.0% of intravenous drug users and 54.6% of hetero-
sexuals (P,.001). Moreover, the prevalence of skin dis-
eases was associated with the progression of HIV disease
regardless of CD4 cell count: overall, 31.0% of patients
in CDC category A had cutaneous symptoms at the time
of the study vs 41.2% in category B and 62.2% in category
C (P,.001), and this association remained significant af-
ter adjustment for CD4 level. Biologically, 81.8% of pa-
tients with a CD4 cell count below 0.050 3 109/L had a
skin disorder vs 51.7% of patients with a count of 0.050

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 Table 4. Prevalence of the 6 Most Frequent Cutaneous Disorders According to Clinical Stage of HIV Infection and CD4 Cell Count,
Groupe d’Epidémiologie Clinique du SIDA en Aquitaine, November to December 1996 (N = 450)*
CDC Category
Cutaneous Disorder A (n = 145) B (n = 182)
Xerosis 8 (5.5) 21 (11.5)
Seborrheic dermatitis 10 (6.9) 17 (9.3)
Pruritus 9 (6.2) 12 (6.6)
Kaposi sarcoma 0 0
Oral candidiasis 0 8 (4.4)
Molluscum contagiosum 1 (0.7) 6 (3.3)
*Patients may have more than 1 diagnosis. Values are given as numbers (percentages). HIV indicates human immunodeficiency virus; CDC, Centers for Disease
Control and Prevention.
†Value has not been computed.
to 0.200 3 109/L and 35.2% of those with a count higher
than 0.200 3 109/L (P,.001). Prevalence of cutaneous dis-
orders was higher among patients receiving a tritherapy
of antiretroviral drugs than among other patients (56.8%
vs 36.5%; P,.001). This association was not observed any-
more after adjustment for CD4 cell count was made, sug-
gesting that this trend was completely explained by the
difference in disease advancement between patients treated
by protease inhibitors and the others.
Prevalence of the 6 most frequent cutaneous disor-
ders according to clinical and biologic markers of HIV
infection is described in Table 4. Because Kaposi sar-
coma is an AIDS-defining disease, its occurrence con-
cerned exclusively patients in CDC category C. Xerosis,
seborrheic dermatitis, and pruritus prevalences did not
statistically differ according to the clinical stage of HIV
disease. Oral candidiasis and molluscum contagiosum oc-
curred more frequently as HIV infection clinically ad-
vanced. All 6 skin disorders except seborrheic dermati-
tis were significantly more frequent in patients with a CD4
cell count below 0.200 3 109/L than in other patients.
None of the other observed cutaneous disorders was sta-
tistically associated with the progression of HIV disease
(data not shown).
COMMENT
Results of this study show a high prevalence of skin dis-
orders among a population of HIV-infected patients seen
in public hospitals. To our knowledge, this is the first pub-
lished prevalence survey on cutaneous disorders in pa-
tients at all stages of HIV disease and followed up in hos-
pital units that do not specialize in dermatology.
Furthermore, the survey was carried out after the intro-
duction of large-scale, combination, antiretroviral drug
therapies.
Our prevalence estimate of skin disorders, 65.3%,
is much lower than that in previous reports: Pitche et al3
reported a prevalence of 82.5% in HIV-infected patients
hospitalized in Togo, West Africa; Coldiron and Berg-
stresser2 observed a prevalence of 92.0% among 100 se-
rial outpatients in Texas; and Goodman et al9 reported
higher prevalence figures of all skin diseases among 117
HIV-infected outpatients and inpatients. However, in these
3 studies, patients were much more advanced in HIV dis-
ease than in our sample: most patients had full-blown
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CD4 Cell Count, 3109/L
C (n = 123) P $0.200 (n = 290) ,0.200 (n = 160) P
15 (12.2) .11 19 (6.6) 25 (15.6) ,.001
14 (11.4) .44 24 (8.3) 17 (10.6) .56
11 (8.9) .64 15 (5.2) 17 (10.6) .05
32 (26.0) . . .† 11 (3.8) 21 (13.1) ,.001
11 (8.9) .001 8 (2.8) 11 (6.9) ,.001
10 (8.1) .006 6 (2.1) 11 (6.9) ,.001
AIDS or had at least non–AIDS-defining symptoms. Simi-
larly, the prevalences of cutaneous disorders reported by
Uthayakumar et al5 and Goldstein et al6 were higher than
those in our study; however, in the former the study popu-
lation included almost exclusively homosexual and
bisexual men, and in the latter, the study setting was a
department of dermatology, with an obvious referral bias.
The GECSA hospital-based information system deals
with at least 80% of the HIV-infected patients known in
the Aquitaine region.16,17 Thus, our results provide an es-
timation of the frequency of skin disorders among a sample
that is representative of the current population of HIV-
infected patients followed up by the hospital wards in
Aquitaine, the third region in France for AIDS reporting.
Using data from a specific questionnaire filled in by
participating physicians in addition to results of the regu-
lar medical examination may still have led to an under-
estimate of the frequency of cutaneous disorders: skin
diseases present at the time of the study but for which
diagnosis requires a careful examination, eg, dermato-
phyte infections, may have been missed by a nonspecial-
ist. Moreover, history of minor cutaneous disorders may
have been underestimated in relation to a recall bias, and
previous cutaneous disorders whose occurrence de-
fined a CDC clinical category were more likely to be well
remembered by physicians. In addition, our estimation
of prevalence of previous skin disorders used 2 sources
of information for the classifying conditions but only 1
source for the others because they were not reported in
the GECSA standardized questionnaire: the capture-
recapture method used when information was provided
by the 2 sources took into account the cases notified by
each of the 2 sources but corrected the possible overlap.
The overall predominance of skin disorders in ho-
mosexual and bisexual men compared with the other HIV
transmission groups, even after exclusion of Kaposi sar-
coma, may be explained by the fact that these patients
usually report more easily their discomfort than the oth-
ers. Moreover, some skin disorders, such as condyloma
or molluscum contagiosum, are known to be caused by
sexually transmitted agents.
Our results show that cutaneous disorders are more
and more frequent as HIV infection clinically advances
and immune function deteriorates, ie, in patients with
full-blown AIDS, with a low CD4 cell count, and whose
status justifies the prescription of a tritherapy of antiret-
1211
roviral drugs. However, the median CD4 cell count of
patients who have skin disorders in our study is high,
close to 0.200 3 109/L, suggesting that most of these cu-
taneous manifestations can occur even early in the course
of HIV disease. The analysis restricted to the subgroup
of patients who had begun a tritherapy of antiretroviral
drugs with a protease inhibitor before the study did not
reveal any particular pattern of skin diseases among these
patients compared with the others.
In conclusion, our report underlines the extent of
the cutaneous disorders throughout the course of HIV
infection. This implies that the occurrence of these skin
disorders in patients not known to be HIV infected must
lead to HIV testing. Moreover, looking systematically for
these troubles in known HIV-infected patients seems es-
sential: their occurrence may reflect a deterioration of the
immune system, and prescription of specific symptom-
atic treatments should be considered because the length
of life of HIV-infected patients is increasing and because
their quality of life is emerging as an important aspect
to take into account in case management. Finally, it will
be interesting to study the future impact of the recent in-
troduction of new antiretroviral drug therapies on the in-
cidence and prevalence of these skin disorders at each
stage of HIV disease.
Accepted for publication March 30, 1998.
This study is part of the Aquitaine Cohort Project funded
by the French “Agence Nationale de Recherches sur le SIDA”
within the coordinated action No. 7: “Cohorts.”
Participants in the Groupe d’Epidémiologie Clinique
du SIDA en Aquitaine are as follows: Organization and epi-
demiological coordination: G. Chene, MD, PhD, F. Dabis,
MD, PhD, and R. Salamon, MD, PhD. Medical coordina-
tion: J. Constans, MD, M. Dupon, MD, D. Lacoste, MD,
D. Malvy, MD, I. Pellegrin, MD, J. F. Moreau, MD, P. Mor-
lat, MD, PhD, J. L. Pellegrin, MD, and J. M. Ragnaud,
MD. Participating hospital departments (participating
physicians): Bordeaux University Hospital, Bordeaux,
France: J. Beylot, MD (P. Morlat, MD, PhD, N. Bernard,
MD, D. Lacoste, MD, and C. Nouts, MD), C. Beylot, MD (M. S.
Doutre, MD), C. Conri, MD (J. Constans, MD), P. Couzi-
gou, MD, H. Fleury, MD (I. Pellegrin, MD), M. Geniaux,
MD (A. Simon), J. Y. Lacut, MD (C. Cazorla, MD, M. Du-
pon, MD, and M. C. Paty, MD), B. Leng, MD (P. Mercie,
MD, P. Rispal, MD, and J. L. Pellegrin, MD), M. LeBras,
MD (D. Malvy, MD, and J. P. Pivetaud, MD), J. F. Moreau,
MD (J. L. Taupin, MD), J. M. Ragnaud, MD (C. De La Taille,
MD, H. Dutronc, MD, D. Neau, MD, and S. Sire, MD),
C. Series, MD, and A. Taytard, MD; Dax Hospital, Dax,
France: M. Loste, MD (I. Blanchard, MD); Bayonne Hospi-
tal, Bayonne, France: F. Bonnal, MD, and M. Ferrand, MD
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©1998 American Medical Association. All rights reserved.
(Y. Blanchard, MD, S. Farbos, MD, and M. C. Gemain,
MD); Libourne Hospital, Libourne, France: J. Ceccaldi, MD,
B. Darpeix, MD, and P. Legendre, MD (X. Jacquelin, MD);
and Villeneuve-sur-Lot Hospital, Villeneuve-sur-Lot, France:
E. Buy, MD, and G. Brossard, MD. Data management and
analysis: J. Caie, RN, M. Decoin, RN, L. Dequae-Merchadou,
MSc, A. M. Formaggio, RN, M. Pontgahet, RN, D. Touchard,
MSc, C. Marimoutou, MD, and G. Palmer, MSc.
Reprints: François Dabis, MD, PhD, INSERM Unit
330, Université Victor Segalen Bordeaux 2, 146 rue Léo
Saignat, 33076 Bordeaux Cedex, France (e-mail:
Francois.Dabis@dim.u-bordeaux2.fr).
REFERENCES
1. Tschachler E, Bergstresser PR, Stingl G. HIV-related skin diseases. Lancet. 1996;
348:659-663.
2. Coldiron BM, Bergstresser PR. Prevalence and clinical spectrum of skin disease
in patients infected with HIV. Arch Dermatol. 1989;125:357-361.
3. Pitche P, Tchangaı̈-Walla K, Napo-Koura G, et al. Prevalence of skin disease in
AIDS patients in the Lome-Tokoin Teaching Hospital of Togo [in French]. Sante.
1995;5:349-352.
4. Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug re-
actions in HIV infection. N Engl J Med. 1993;328:1670-1674.
5. Uthayakumar S, Nandwani R, Drinkwater T, Nayagam AT, Darley CR. The preva-
lence of skin disease in HIV infection and its relationship to the degree of im-
munosuppression. Br J Dermatol. 1997;137:595-598.
6. Goldstein B, Berman B, Sukenik E, Frankel SJ. Correlation of skin disorders with
CD4 lymphocyte counts in patients with HIV/AIDS. J Am Acad Dermatol. 1997;
36:262-264.
7. Smith KJ, Skelton HG, Yeager J, et al. Cutaneous findings in HIV1-positive pa-
tients: a 42-month prospective study. J Am Acad Dermatol. 1994;31:746-754.
8. Dover JS, Allen Johnson R. Cutaneous manifestations of HIV infection. Arch Der-
matol. 1991;127:1383-1391.
9. Goodman DS, Teplitz ED, Wishner A, et al. Prevalence of cutaneous disease in pa-
tients with AIDS or AIDS-related complex. J Am Acad Dermatol. 1987;17:210-220.
10. Centers for Disease Control. 1993 Revised classification system for HIV infec-
tion and expanded surveillance case definition for AIDS among adolescents and
adults. MMWR Morb Mortal Wkly Rep. 1992;41:1-20.
11. Cockerell CJ. Human immunodeficiency virus infection and the skin: a crucial
interface. Arch Intern Med. 1991;151:1295-1303.
12. Dabis F, Chene G, Salamon R, et al. Hospital-based surveillance of HIV infection:
Bordeaux, France 1983-1990. AIDS. 1991;5:774-775.
13. Marimoutou C, Chene G, Dabis F, et al. Human immunodeficiency virus and AIDS
hospital-based information system in Aquitaine, South-Western France, 1985-
1995 [in French]. Presse Med. 1997;26:703-710.
14. Hubert B, Desenclos JC. Evaluation of the exhaustivity and representativeness
of a surveillance system by the capture-recapture method: application to sur-
veillance of meningococcal infections in France in 1989 and 1990 [in French].
Rev Epidemiol Sante Publique. 1993;41:241-249.
15. Bernillon P, Lievre L, Pillonel J, Laporte A, Costagliola D. Estimation de la sous-
déclaration des cas de SIDA en France par la méthode de capture-recapture. Bull
Epidemiol Hebd. 1997;5:19-21.
16. Lacoste D, Marimoutou C, Dabis F, et al. Decreasing incidence of HIV infection
among intraveinous drug users: Aquitaine (South-West France), 1985-1993 [in
French]. Presse Med. 1996;25:1018-1022.
17. De Chabalier F, Decoin M, Bonarek M, Ortega V, Marimoutou C, Dabis F. Hospital-
based surveillance and emerging patterns of HIV transmission. AIDS. 1996;10:
552-553.