Overview

Skin and mucosal conditions are extremely common in all children and adults in particular in HIV-infected adults and children and are one of the commonest daily management problems faced by health care workers caring for patients with HIV infection. As the CD4 count declines below 200 cells/mm3, the prevalence, spectrum and severity of skin and oral conditions increases. Although not a major cause of mortality, skin and mucosal conditions can be a source of severe morbidity through intractable pruritus that provokes scratching, disfigurement, sleep disturbance, pain on swallowing, and psychological stress.

Several infectious, inflammatory, and neoplastic skin and mucosal conditions are pathognomonic of HIV/AIDS, e.g. Kaposi sarcoma, herpes zoster, papular pruritic eruption and extensive candidiasis. The World Health Organization’s department of Maternal, Newborn, Child and Adolescent Health in collaboration with HIV/AIDS has selected ten skin and mucosal conditions based on burden of disease and has developed the guidelines on treatment. There is also an accompanying tool on the clinical algorithms for the recognition of these conditions.

Contents

• Abbreviations and acronyms
• Definitions of key terms
• Acknowledgements
• Executive summary
• Summary of recommendations
• 1. Introduction
  • 1.1 Background and context
  • 1.2 Rationale for new guidelines
  • 1.3 Why guidelines are needed
  • 1.4 Objectives
  • 1.5 Target audience
  • 1.6 Scope of guidelines: which skin conditions to address?
  • 1.7 Methodology
  • 1.8 Review and update of recommendations
• 2. Tool to aid in diagnosis of skin conditions
• 3. Guiding principles for HIV testing, ART initiation and general care
• 4. Evidence and recommendations on Kaposi sarcoma (KS)
  • 4.1 Background
  • 4.2 Recommendations
  • 4.3 Review question and summary of evidence
  • 4.4 Rationale for recommendations
  • 4.5 Other considerations for implementation and in choice of chemotherapy regimen
  • 4.6 Research gaps
• 5. Evidence and recommendations on seborrhoeic dermatitis
  • 5.1 Background
  • 5.2 Recommendations
  • 5.3 Review question and summary of evidence
  • 5.4 Rationale for recommendations
  • 5.5 Research gaps
• 6. Evidence and recommendations on papular pruritic eruption
  • 6.1 Background
  • 6.2 Recommendations
  • 6.3 Review question and summary of evidence
  • 6.4 Considerations for development of recommendations
  • 6.5 Research gaps
• 7. Evidence and recommendations on eosinophilic folliculitis
  • 7.1 Background
  • 7.2 Recommendations
  • 7.3 Review question and summary of evidence
  • 7.4 Rationale for recommendations
  • 7.5 Research gaps
• 8. Evidence and recommendations on tinea infections
  • 8.1 Background
  • 8.2 Recommendations
  • 8.3 Review question and summary of evidence
  • 8.4 Rationale for recommendations
  • 8.5 Research gaps
• 9. Evidence and recommendations on herpes zoster
  • 9.1 Background
  • 9.2 Recommendations
  • 9.3 Review question and summary of evidence
  • 9.4 Rationale for recommendations
  • 9.5 Research gaps
• 10. Evidence and recommendations on scabies
  • 10.1 Background
  • 10.2 Recommendations
  • 10.3 Review question and summary of evidence
  • 10.4 Rationale for recommendations
  • 10.5 Research gaps
• 11. Evidence and recommendations on molluscum contagiosum
  • 11.1 Background
  • 11.2 Recommendations
  • 11.3 Review question and summary of evidence
  • 11.4 Rationale for recommendations
  • 11.5 Research gaps
• 12. Evidence and recommendations on oropharyngeal candidiasis
  • 12.1 Background
  • 12.2 Recommendations
  • 12.3 Review question and summary of evidence
  • 12.4 Rationale for recommendations
  • 12.5 Research gaps
• 13. Evidence and recommendations on Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis
  • 13.1 Background
  • 13.2 Recommendations
  • 13.3 Review question and summary of evidence
  • 13.4 Rationale for recommendations
  • 13.5 Research gaps
• 14. Dissemination, implementation and monitoring of these guidelines
  • 14.1 Guidelines dissemination
  • 14.2 Guidelines implementation
  • 14.3 Monitoring and evaluating guidelines implementation
• References
• Annexes
  • Annex 1 ART recommendations
  • Annex 2 Drug Interactions
  • Annex 3 Drug treatment regimens, dosage and cost
• Web appendices
  • Web Appendix 1 GRADE tables
  • Web Appendix 2 Tool to aid in diagnosis of skin conditions

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