Journal of Clinical and Diagnostic Research. 2017 Nov, Vol-11(11): WC05-WC10 5 5 DOI: 10.7860/JCDR/2017/29624.10873 Original Article Dermatology Section 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 INTRODUCTION The skin remains an important window through which many internal diseases including Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome (HIV/AIDS) is put into proper perspectives. Since the onset of the ongoing HIV/AIDS pandemic, close to 60 million people have been infected, of which about 30 million sufferers had died [1]. Approximately, 69% of the People Living with HIV/AIDS (PLWHA) are dwellers of the sub-Saharan African countries [1]. The dermatologists are playing prominent roles in the diagnosis of sentinel skin/mucosa disorders, management of the disease, alleviation of suffering contributed by the HIV-related skin diseases and curbing of the spread of the disease through effective treatment of other sexually transmitted infections [1,2]. Because the skin is prominently affected, it is widely known, even among the laymen that the sight of peculiar or extensive skin diseases raises the suspicion of the presence of HIV. Studies have shown that certain HIV-related skin diseases correlated with the severity of immunosuppression in HIV/AIDS patients and that the prevalence of mucocutaneous disorders varied widely with geographical locations [2-5]. Although HIV-related skin and mucosa disorders have been studied exhaustively, diseases affecting the hair, nails and their predictive implication on low CD4+ cell count were scarcely documented in African studies [6-9]. During day to day office consultation with PLWHA, examination of the hair, nails and oral mucosa formed an essential component of the general physical examination. Easy access to these areas of the human body at no cost to the patients is advantageous, considering the potentials of serving as a quick and straight forward way of putting the extent of immunosuppression in HIV/AIDS into perspectives. Efforts to find accurate cutaneous predictors or the correlates of the degree of immune involvement in HIV/AIDS continue as resource allocation is dwindling in the tropical Africa. Discovery of any such reliable alternatives would reduce expenses and serve as a quick point of care reference that could aid quick decision making in areas with scarce resources. A study like this that attempts to solve resource related questions and which have a point of care potential are needed in sub-Sahara Africa. This type of study is relevant because the HIV disease and its ADEOLU OLADAYO AKINBORO 1 , EDWARD OLUGBENGA AYODELE 2 , OLANIYI EMMANUEL ONAYEMI 3 Keywords: Hair disorders, Nails diseases, Oral lesions ABSTRACT 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 36.68±10.03 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/mm 3 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/mm 3 , hence cannot replace the CD4 count machine but their absence make the presence of CD4+cells count <200 cells mm 3 reliably unlikely.