Guidelines on skin and oral HIV-associated conditions in children and adults

1. Guidelines on skin and oral HIV-associated conditions in children and adults WHO  Department of Maternal, Newborn, Child and Adolescent Health Department of HIV/AIDS

2. Mucocutaneous manifestations in HIV • Common • High morbidity & mortality • Could be an indicator disease

3. Objectives …to provide a summary of key evidence and practice recommendations on treatment of the main skin and oral conditions in HIV-infected adults and children

4. What are these guidelines about? Criteria for selection • Burden of disease • Severity • Impact on prognosis of HIV • Marker of low CD4 initiation of ART • Applicability for primary health care levels in resource-poor settings

5. What are these guidelines about?

6. Who is the target audience? Managersof HIV/AIDS control programmes Policy makers Health proffesionals in settings with HIV infection, primarily where resources are limited.

7. Kaposi SarcomaSelection of patients for chemotherapy • No standardized criteria presently • Extent of tumour alone may be insufficient • Categorization of KS into mild/moderate & severe symptomatic based on the original ACTG tumour extent criteria

8. Kaposi Sarcoma * Pending approval by the WHO guideline Review Committee

9. Kaposi Sarcoma Recommended Regimens * Pending approval by the WHO guideline Review Committee

10. Seborrheic dermatitis * Pending approval by the WHO guideline Review Committee

11. Pruriticpapular eruption * Pending approval by the WHO guideline Review Committee

12. Eosinophilicfolluculitis * Pending approval by the WHO guideline Review Committee

13. Tinea * Pending approval by the WHO guideline Review Committee

14. Herpes zoster * Pending approval by the WHO guideline Review Committee

15. Scabies * Pending approval by the WHO guideline Review Committee

16. Molluscumcontagiosum * Pending approval by the WHO guideline Review Committee

17. OropharyngealCandidiasis * Pending approval by the WHO guideline Review Committee

18. Stevens-Johnson Syndrome * Pending approval by the WHO guideline Review Committee

19. Tool to aid in diagnosis of skin conditions After input from dermatologists in the field, the tool was refined to include better diagnostic criteria, additional diagnoses of relevance, additional pictures of children and of skin diseases in diverse subjects.

20. The research gaps Common to all conditions… • Research in HIV infected • Research in Children • Standardized outcome measures • Well designed prospective, randomized double blind studies with adequate power • Effect of ART … does it manifest as an IRIS

21. Thank you! Contributors to the GRADE systematic reviews and supporting evidence Esther Freeman (Harvard Medical School, USA), Toby Maurer (University of California, USA), OluwatoyinGbabe (Stellenbosch University, South Africa), Charles L. Okwundu(Stellenbosch University, South Africa), Miriam Laker (University of California, USA), Philippa J. Easterbrook (World Health Organization, Switzerland), Jeffrey Martin (University of California, USA), Martin Dedicoat (Birmingham Heartlands Hospital, United Kingdom).Andrew Anglemyer (University of California, USA), Anurag K. Agarwal (Baylor College of Medicine, USA), George W. Rutherford (University of California, USA). John Stephen (St. John's Medical College, India) Tony Raj (St. John's Medical College, India), Kedar Radhakrishna (St. John's Medical College, India), Tinku Thomas (St. John's Medical College, India). Ser Ling Chua (University Hospital Birmingham, United Kingdom), Kedar Radhakrishna (St. John's Medical College, India), John Stephen (St. John's Medical College, India), Mike Zangenberg (World Health Organization, Switzerland).Mamaduo O. Diallo (Centers for Disease Control and Prevention, USA), Magdy El-Gohary (University of Southampton, United Kingdom), Esther J. van Zuuren (Leiden University, Netherlands), Hana Burges (University of Southampton, United Kingdom), Liz Doney (University of Nottingham, United Kingdom), ZbysFedorowicz (Cochrane Collaboration Awali, Bahrain), Michael Moore (University of Southampton, United Kingdom), Paul Litle (University of Southampton, United Kingdom).DunjaVekic(St. Vincent’s Hospital, Australia), Lisa Abbot (St. Vincent’s Hospital, Australia), Emily Asher (University of California, USA), Margot Whitfeld(Skin and Cancer Foundation, Australia). Elissa M. McDonald (University of Auckland, New Zealand), Johannes de Kock (Wanganui Hospital, New Zealand), Feliz S.F. Ram (Massey University, New Zealand), Cristina C. Chang (Monash University, Australia), Vivek Naranbhai (Doris Duke Medical Research Institute, South Africa), Allen C. Cheng (Monash University, Australia), Monica Slavin (Peter MacCallum Institute, Australia), Abijeet Waghmare (St. John's Medical College, India).Paul Harris (London School of Hygiene & Tropical Medicine, United Kingdom)Elizabeth D. Pienaar (Medical Research Council, South Africa), Taryn Young (Medical Research Council, South Africa), Haly Holmes (University of Western Cape, South Africa). WHO Staff and Consultants Lulu Muhe, Philippa Easterbrook, Mike Zangenberg, Elizabeth, Frank Lule, Kasonde Mwinga, Meg Doherty, Rajiv Bahl, Wilson Were, Peggy Henderson,