Cytological findings of skin lesions among HIV infected patients attending the comprehensive care clinic at Kenyatta national hospital, Nairobi.

Abstract

According to WHO report of 2011, there were 34.0 million people living with Human immunodeficiency virus (HIV) in the world. Sub-Saharan Africa remains most severely affected, with South Africa carrying the largest burden. In 2012, Kenya showed that approximately 5.6% of the adult population was HIV infected. Cytopathology of skin lesions in HIV infection has been poorly studied in sub-Saharan Africa. HIV infected individuals are living longer due to HAART. The spectrum of cutaneous malignancies has expanded to include both AIDS defining cancers as well as non AIDS defining cancers (NADC).These skin conditions impair patients’ quality of life. Using exfoliative cytology, this study highlighted on specific infections, inflammations, ulcerations and neoplasms likely to be encountered in this setting and has also given the current shift in the pattern of HIV related diseases thus improving on patient care. Objective: To describe the cytological findings of skin lesions in HIV infected patients that attended CCC at Kenyatta National Hospitals, Nairobi. Design: A cross- sectional descriptive study. Setting: Recruitment and sample collection was done at CCC at KNH. Sample processing was done at UON cytology laboratory. Study Population: HIV infected patients in the CCC at KNH who had skin complaints and met the inclusion criteria. Method: One hundred (100) patients were recruited and group counselled on the importance of the study. A structured questionnaire was used to collect socio-demographic information and clinical history. Cytology sampling techniques: touch preparations, FNA and scrapings were used to collect the material from the lesions. Three smears of the collected material were made. Two were stained with Papanicolaou and heamatoxylin respectively, and the other air dried for special stain. In this study Periodic acid Schiff and Ziehl Neelsen stains were used as warranted. The principal investigator examined the preparations then reviewed them with the pathologists. A tie breaker was sought for controversial cases. Results: All participants were black. The female to male ratio in this study was 3:1 (73% & 27% respectively. The peak age group was 41 to 50 years (36%) with mean age of 41.47yrs, (SD of 11.46). Majority hailed from Nairobi County. Cytological findings; 41% were negative for cytological lesions, 32% were inflammatory (Nonspecific inflammation 21%, viral 6% and 5% fungal), 5% were malignant (KS 2% and SCC 3%) and for the purpose of analysis 22% were grouped as others. There was a significant difference on skin cytology and clinical findings at 95% confidence interval because the p value was less than 0.001 and the chi square statistics was 1089. There was no evidence of significant difference in cytological findings of patients on and not on HAART. Conclusion: The commonest cytological changes were inflammatory. Malignant skin lesions are rare presentations in HIV infection among the studied population. Recommendations: Cytology is a valuable, affordable and a quick diagnostic tool that should be incorporated in the routine management of HIV-related skin lesions.