Introduction:
The human immunodeficiency virus is a health concern around the globe, and it has far-reaching implications. Beyond its impact on the immune system, HIV can lead to various changes in various ways throughout the body, often revealing itself through subtle signs. One such indicator that has gained attention in recent years is the effect of HIV on nails. Nails, though generally overlooked, can give valuable insights into an individual's overall health, including the presence and progression of HIV.
What Is Human Immunodeficiency Virus (HIV)?
Before understanding the complex relationship between HIV and nails, it is important to comprehend the nature of the virus itself. HIV attacks the immune system, specifically the CD4 cells (T cells), which play an essential role in protecting the body against infections and diseases. As the virus progresses, it weakens the immune system and makes the body susceptible to various infections and complications.
What Is the Effect of HIV on Nails?
Nails serve as a mirror to the internal health of an individual, reflecting changes and abnormalities that might otherwise go undiagnosed. Individuals living with HIV might experience several nail-related issues that can serve as subtle indicators of their immune system's compromised state. The changes in the nails of people living with HIV have aroused an interest in recent years. There is a wide range of mucocutaneous changes or skin diseases related to human immunodeficiency virus (HIV) infection. The most commonly occurring alterations include
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Longitudinal melanonychia (brown or black discoloration of a nail).
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Leukonychia (white discoloration of the nails).
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Beau's lines (transverse depressions).
Onychomycosis:
Individuals with HIV frequently face challenges in maintaining a strong immune response against fungal infections. As the immune system weakens, opportunistic fungi can take advantage, leading to conditions such as onychomycosis – a fungal infection that affects the nails. The nails may become discolored, thickened, and brittle, providing a visual cue of the underlying health issues.
This clinical condition is one of the early manifestations of HIV infection, with a prevalence of approximately 10 to 44 %. Non-dermatophyte molds are responsible for 2 to 12 % of onychomycosis, with differences depending on the population and geographic area recorded. The frequency is four times higher in patients with HIV. The non-dermatophyte molds (NDM) group is most often isolated in onychomycosis samples, and among these, Candida parapsilosis has been documented as the main etiologic agent in people with HIV.
The incidence of onychomycosis has reduced in patients with HIV/AIDS (autoimmune disorder) after the introduction of combined antiretroviral therapy (cART) and the prophylactic use of antifungal agents when indicated. However, this disease contributes to a significant source of morbidity.
Longitudinal Melanonychia:
Longitudinal melanonychia refers to the presence of dark-pigmented streaks running lengthwise along the nail plate. These streaks are generally brown or black in color and can involve one or multiple nails. While longitudinal melanonychia is not specific to HIV and can have various causes, it may be observed in individuals living with HIV/AIDS.
Leukonychia:
Leukonychia refers to the presence of white discoloration or white spots on the nails. This condition can have various causes, including trauma, fungal infections, nutritional deficiencies, and systemic diseases. While leukonychia itself is not specific to HIV, it can be observed in individuals living with the virus, often as a result of associated factors.
Yellowing and Discoloration:
Changes in nail color, particularly yellowing, can be associated with HIV. The virus compromises the body's ability to fight off infections, allowing bacteria and fungi to thrive. Yellowing of the nails can signify the presence of secondary infections or underlying health concerns related to HIV.
Kaposi's Sarcoma:
In some cases, individuals with advanced HIV may develop a type of cancer known as Kaposi's sarcoma. This cancer can affect the skin and internal organs, including the nails. Kaposi's sarcoma may present as discolored, dark, or brown streaks beneath the nail bed, serving as a distinctive marker of advanced HIV progression. Kaposi's sarcoma can give rise to tumors in the nail bed. These tumors show characteristic raised nodular masses under the nail plate. The presence of these tumors can distort the normal structure of the nail and may cause pain or discomfort. In certain cases, Kaposi's sarcoma can cause separation of the nail plate from the nail bed (onycholysis). This separation can lead to changes in the appearance and texture of the nail, with the affected area often appearing whitish or yellowish.
Beau's Lines:
Beau's lines are transverse depressions or grooves that can appear across the nails. They are often associated with periods of extreme stress or illness. In the context of HIV, these lines may manifest due to the overall impact of the virus on the body, signaling a moment of heightened stress and immune system strain.
Clubbing:
Clubbing is defined by the increased curvature of the nails, causing them to appear rounded or bulbous. The angle between the nail and the fingertip, known as the Lovibond angle, increases. In HIV-related clubbing, this change can be gradual and is often more pronounced in the later stages of the disease. Clubbing is a result of reduced oxygen levels in the blood and might indicate severe underlying health issues. The angle between the nail and the proximal nail fold, known as the Schamroth's window, diminishes in clubbing. In HIV-related cases, this loss of the normal angle is indicative of the underlying physiological changes associated with advanced disease.
Conclusion:
Nails, though small and comparatively insignificant, can act as valuable indicators of an individual's health, offering clues about the presence and progression of diseases such as HIV. It is important for healthcare professionals and individuals alike to pay attention to changes in nail health, as these subtle signs can prompt early detection and intervention.
As research on HIV and its impact on various bodily functions continues, understanding the nuanced connections between the virus and seemingly unrelated symptoms like nail abnormalities becomes increasingly important. By recognizing these signs early on, individuals living with HIV can seek timely medical assistance, allowing for better management of the virus and its associated complications. Additionally, raising awareness about the link between HIV and nail health can contribute to a more comprehensive understanding of the virus and its diverse effects on the human body.
