To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)–infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects.
Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed.
Primary care university hospital.
A total of 155 HIV-1–positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio.
Main Outcome Measure
Clinical examination findings.
Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P<<.001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P<.05), transverse lines (7.1%) (P<.01), onychoschizia (7.1%) (P<.05), leukonychia (14.3%) (P<.001), and longitudinal melanonychia (14.8%) (P<.01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P<.001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients.
Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.