Hair, Nails and Oral Mucosal Disorders among People Living with Human Immunodeficiency Virus and AIDS in Osogbo and Diagnostic Performance on Low CD4 Cells Count

Abstract

Introduction: The epidemic of HIV/AIDS continues amidst reduce funding in most low and middle-income countries. The need to find low-cost clinical equivalents of the laboratory markers of immunosuppression, therefore become imperative. Aim: To document hair, nails and oral mucosal disorders among People Living with HIV/AIDS (PLWHA) and determine their performance in predicting low CD4 count. Materials and Methods: This cross-sectional study included 315 patients recently diagnosed PLWHA at the HIV clinic of LAUTECH Teaching Hospital, Osogbo, Nigeria. Participants were examined for hair, nails, and oral mucosal disorders and CD4+ cell count was estimated. Sensitivity, specificity, positive and negative likelihood ratio were calculated using online MedCalcR. Results: Mean age of participants was 36.68±10.03 years, and 227 (72.1%) were female. The CD4+cell count below 200 was significantly associated with lower weight, BMI and male gender. The prevalence of integument and oral lesions include blue-black nail pigmentation 17.8%, oral candidiasis 17.5%, fluffy hair 14.9%, lighter colour hair 13.8%, diffuse alopecia 9.2%, oral hyperpigmentation 7.3%, and onychomycosis 5.4%. Disorders significantly associated with median CD4 count <200 cells/mm3 include: blue-black nail pigmentation (p <0.001), fluffy hair (p<0.001), lighter colour hair (p=0.002), oral candidiasis (p=0.004) and aphthous ulcers (p=0.004). Performance of hair, nails and oral disorder in detecting CD4+ cell count <200: Blue nails: sensitivity 92.9%, specificity 64.1%, positive likelihood ratio 2.6, and negative likelihood ratio 0.1; onychomycosis: sensitivity 70.6%, specificity 55.4%, positive likelihood ratio 1.6, and negative likelihood ratio 0.5; fluffy hair: sensitivity 70.2%, specificity 58.2%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; lighter colour hair: sensitivity 74.1%, specificity 56.6%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; Oral candidiasis: sensitivity 78.2%, specificity 60.8%, positive likelihood ratio 2.0, and negative likelihood ratio 0.4. The combinations in twos and threes increased the sensitivity (88.9-100.0%) and negative predictive values (85.7-100%), but specificities are reduced below 50%. Conclusion: Although blue-black nail pigmentation, fluffy hair, lighter colour hair, oral candidiasis are associated with low CD4 count, their presence is not a good diagnostic test to detect CD4 count <200 cells/mm3 , hence cannot replace the CD4 count machine but their absence make the presence of CD4+cells count <200 cells mm3 reliably unlikely.

Keywords

• hair disorders
• nails diseases
• oral lesions