BI08 Defining the burden of mucocutaneous disease in organ transplant recipients living with HIV: the Mucocutaneous disorders in Organ Transplant recipients living with HIV study
Authors: Junejo Muhammad Hyder , Cernova Jeva , Bowring Julie , Cuming Tamzin , Murphy Maurice , Booth John , Harwood Catherine 
Published: June 2023

Abstract
Organ transplant recipients (OTRs) have a high incidence of skin disease. People living with HIV (PLWH) are also at increased risk of skin disease, despite highly active antiretroviral therapy. Dual immunosuppressive states would be expected to increase substantially the risk of mucocutaneous disease, including skin infections and malignancy, but this is not well documented. The aim of the MOTH (Mucocutaneous disorders in Organ Transplant recipients living with HIV) study is to assess the burden of skin disease in PLWH who are also OTRs. The first phase of the MOTH study was a single-centre observational study of PLWH who had received a solid organ transplant at our centre, following their HIV diagnosis. We identified eligible patients through our OTR database. Demographic data and details of previous/current skin disease were collected. Patients with a documented full skin examination (FSE), including anogenital skin assessment within the previous 3–6 months, were not recalled for clinical review. Those not reviewed within the prior 6 months or those without a documented anogenital skin examination (even if they had a FSE within the past 6 months) were invited for clinical review. Thirty OTRs living with HIV were identified. Twenty-five were clinically assessed in person and case notes reviewed for five. Fourteen patients were men and 16 were women; mean age was 55 years (range 31–70). Most (n = 25; 83%) were Black African; the remainder were Black Caribbean (n = 3), White (n = 1) and mixed race (n = 1). Only two patients identified as men who have sex with men (MSM). Human papillomavirus (HPV)-associated disorders were the most common mucocutaneous conditions identified with 31 separate diagnoses in 19 (63%) patients: non-anogenital cutaneous warts (n = 9); low-risk HPV-related anogenital disease (n = 14); premalignant HPV-related anogenital disease (n = 6) and HPV-associated malignant disease (n = 2; vulval squamous cell carcinoma in situ and oral mucosal carcinoma). One patient (White, MSM) had been HPV vaccinated pretransplant. Other diagnoses included cutaneous/nail fungal infections (n = 10), HSV infection (n = 10), pruritus associated with renal replacement therapy (n = 7), bacterial skin infection (n = 4), steroid-induced folliculitis (n = 3), Kaposi sarcoma (n = 3), lichen sclerosus (n = 1), acquired erythro­dysplasia verruciformis (n = 1), erythema multiforme (n = 1), lichen simplex chronicus (n = 1) and cytomegalovirus-associated perioral ulceration (n = 1). These findings confirm a high burden of skin disease in OTRs living with HIV. HPV-related mucocutaneous disease was particularly common, supporting the need for routine HPV-related anogenital surveillance and guidance on pretransplant HPV vaccination. Further prospective research is required to define the mucocutaneous health-related needs of this cohort, and an international multicentre extension of the MOTH study is currently underway.