[Mollusca contagiosa in HIV infection. Clinical manifestation, relation to immune status and prognostic value in 39 patients].

Mollusca contagiosa predominantly affect children; their occurrence in adults is rare. In recent years many descriptions of mollusca contagiosa in immunosuppressed patients, mostly in HIV-infected individuals, have appeared. We analysed the occurrence of mollusca contagiosa in a large group of HIV-patients and examined their relation to the immune status and their prognostic significance. 456 patients with HIV-associated skin disorders were documented in the HIV follow-up clinics at the Department of Dermatology, University Medical Center Benjamin Franklin, Berlin, during the years 1982-1992. Molluscum contagiosum was diagnosed in 39 patients (8.6%). 38 of the 39 patients were homosexual and/or bisexual men. The median age of the patients was 34 years. Large, papular and nodular lesions up to 1 cm in diameter were observed in some, individuals. Frequently, multiple lesions in atypical localizations such as the face were found. Significant immunosuppression was present in the majority of patients with mollusca contagiosa at the time of their first diagnosis; median CD(4+)-T-lymphocyte count was 122/microliter and the median CD4+/CD(8+)-ratio was 0.2. The median survival time was 12 months in patients with mollusca contagiosa. There was no significant difference between the prognosis of patients with mollusca contagiosa and other HIV-infected patients showing similar reduction of their immune status. Our study showed that mollusca contagiosa are a rather frequent infection in HIV-patients. Mainly localized to the face, they are easily diagnosed and may serve as an excellent clinical marker for recognizing advanced immunosuppression in HIV-infection. Survival prognosis of patients with molluscum contagiosum is unfavourable, corresponding to their reduced immune status. The presence of mollusca, however, is not an independent prognostic marker, if the immune status is considered.