Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : November | Volume : 11 | Issue : 11 | Page : WC05 - WC10

Hair, Nails and Oral Mucosal Disorders among People Living with Human Immunodeficiency Virus and AIDS in Osogbo and Diagnostic Performance on Low CD4 Cells Count

Adeolu Oladayo Akinboro, Edward Olugbenga Ayodele, Olaniyi Emmanuel Onayemi

1. Lecturer, Department of Dermatology Unit and Internal Medicine, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria. 2. Professor, Department of Internal Medicine, Ladoke Akintola University of Technology and LAUTECH Teac, Ogbomoso, Oyo State, Nigeria. 3. Professor, Department of Dermatology and Venereology, Obafemi Awolowo University and OAUTHC, Ile-Ife, Osun State, Nigeria.

Correspondence Address :
Dr. Adeolu Oladayo Akinboro,
P.O.BOX 3033, Dada Estate, Osogbo, Osun State, Nigeria.


Introduction: The epidemic of HIV/AIDS continues amidst reduce funding in most low and middle-income countries. The need to find low-cost clinical equivalents of the laboratory markers of immunosuppression, therefore become imperative.

Aim: To document hair, nails and oral mucosal disorders among People Living with HIV/AIDS (PLWHA) and determine their performance in predicting low CD4 count.

Materials and Methods: This cross-sectional study included 315 patients recently diagnosed PLWHA at the HIV clinic of LAUTECH Teaching Hospital, Osogbo, Nigeria. Participants were examined for hair, nails, and oral mucosal disorders and CD4+ cell count was estimated. Sensitivity, specificity, positive and negative likelihood ratio were calculated using online MedCalcR.

Results: Mean age of participants was 36.6810.03 years, and 227 (72.1%) were female. The CD4+cell count below 200 was significantly associated with lower weight, BMI and male gender. The prevalence of integument and oral lesions include blue-black nail pigmentation 17.8%, oral candidiasis 17.5%, fluffy hair 14.9%, lighter colour hair 13.8%, diffuse alopecia 9.2%, oral hyperpigmentation 7.3%, and onychomycosis 5.4%. Disorders significantly associated with median CD4 count <200 cells/mm3 include: blue-black nail pigmentation (p <0.001), fluffy hair (p<0.001), lighter colour hair (p=0.002), oral candidiasis (p=0.004) and aphthous ulcers (p=0.004). Performance of hair, nails and oral disorder in detecting CD4+ cell count <200: Blue nails: sensitivity 92.9%, specificity 64.1%, positive likelihood ratio 2.6, and negative likelihood ratio 0.1; onychomycosis: sensitivity 70.6%, specificity 55.4%, positive likelihood ratio 1.6, and negative likelihood ratio 0.5; fluffy hair: sensitivity 70.2%, specificity 58.2%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; lighter colour hair: sensitivity 74.1%, specificity 56.6%, positive likelihood ratio 1.7, and negative likelihood ratio 0.5; Oral candidiasis: sensitivity 78.2%, specificity 60.8%, positive likelihood ratio 2.0, and negative likelihood ratio 0.4. The combinations in twos and threes increased the sensitivity (88.9-100.0%) and negative predictive values (85.7-100%), but specificities are reduced below 50%.

Conclusion: Although blue-black nail pigmentation, fluffy hair, lighter colour hair, oral candidiasis are associated with low CD4 count, their presence is not a good diagnostic test to detect CD4 count <200 cells/mm3, hence cannot replace the CD4 count machine but their absence make the presence of CD4+cells count <200 cells mm3 reliably unlikely.


Hair disorders, Nails diseases, Oral lesions

How to cite this article :

Adeolu Oladayo Akinboro, Edward Olugbenga Ayodele, Olaniyi Emmanuel Onayemi. HAIR, NAILS AND ORAL MUCOSAL DISORDERS AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS AND AIDS IN OSOGBO AND DIAGNOSTIC PERFORMANCE ON LOW CD4 CELLS COUNT. Journal of Clinical and Diagnostic Research [serial online] 2017 November [cited: 2018 Jan 21 ]; 11:WC05-WC10. Available from

DOI and Others

DOI: 10.7860/JCDR/2017/29624.10873

Date of Submission: May 08, 2017
Date of Peer Review: Jun 22, 2017
Date of Acceptance: Aug 18, 2017
Date of Publishing: Nov 01, 2017


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