Abstract

Background. Onychomycoses are a common manifestation of opportunistic infections in HIV-infected patients. Investigation of the clinical forms and depth of nail involvement in HIV-positive individuals with different responses to antiretroviral therapy (ART) enables a better understanding of the characteristics of these mycoses and contributes to the optimization of treatment strategies.
Aim: is to establish the clinical features of foot onychomycosis in HIV-infected patients depending on the effectiveness of antiretroviral therapy.
Materials and methods. 96 HIV-infected patients with onychomycosis of the feet were under observation. The diagnosis of HIV infection was established according to the International Classification of Diseases of the 10th revision (ICD-10) and verified by the detection of specific serological and molecular biological markers of HIV. The number of CD4+-lymphocytes and viral load (copies/ml) were recorded in all patients. Depending on the immunological and virological response to ART, patients were divided into 4 groups: group I, which included 30 (31.3%) people, included patients who achieved virological and immunological success from treatment: a decrease in the viral load to an undetectable level (<50 copies/ml) and an increase in the number of CD4+ lymphocytes to values >500 cells/μl; to the II group (20 patients – 20.8%) – with a decrease in the viral load, but without an increase in the number of CD4+-lymphocytes; to the III group (11 patients – 11.5%) – with an increase in the level of CD4+ >500 cells/μl, but without a decrease in the viral load; to IV group (35 people – 36.5%) – with virological and immunological ART failure. The control group included 33 patients with onychomycosis of the feet who did not have HIV infection or associated diseases.
Results. Statistical analysis established the pattern of distribution of clinical forms of onychomycosis of the feet of HIV-infected patients in groups formed depending on the results of antiretroviral therapy (p < 0.01), as well as the relationship between the depth of nail plate damage and clinical forms of foot onychomycosis in HIVinfected patients ( p < 0.01). In HIV-infected patients of the I group, 1-3 nails were mostly affected; II group – 5-8 nails; III and IV groups – 8-10 nails, which was statistically significant. The distribution of onychomycosis of the feet in HIV-infected patients according to the depth of the nail plates in the groups receiving antiretroviral therapy was statistically confirmed.
Conclusions. Onychomycosis of the feet in HIV-infected patients receiving antiretroviral therapy is characterized by the prevalence of lesions involving 8-10 nails in 30.2% of patients and the depth of lesions exceeding 2/3 of the nail plate in 50.0% of patients