Nail changes in patients infected with human immunodeficiency virus -: A prospective controlled study

Objectives: To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)infected patients and to evaluate the: specificity of these findings by comparison with HIV-negative control subjects. Design: Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). in case of clinical diagnosis of onychomycosis, mycological culture was performed. Setting: Primary care university hospital. Patients: A total of 155 HIV-I-positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio. Intervention: None. Main Outcome Measure: Clinical examination findings. Results: Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P<<.001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P<.05), transverse lines (7.1%) (P<.01), onychoschizia (7.1%) (P<.05), leukonychia (14.3%) (P<.001), and longitudinal melanonychia (14.8%) (P<.01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P<.001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple Fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients. Conclusion: Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.