A patient infected with the human immunodeficiency virus (HIV) is at increased risk for onychomycosis. The decision to treat the infection aggressively may be influenced by a number of clinical factors.
The risk for onychomycosis tends to increase in a patient infected with HIV:
(1) when the CD4 lymphocyte count falls below 450 per µL (0.45 * 10^9 per liter)
(2) if the patient has other risk factors for onychomycosis (diabetes, steroid therapy, etc)
Indications for aggressive management of onychomycosis:
(1) extensive nail involvement
(2) onychodystrophy
(3) emotional stress including stigmatization
(4) pain or significant physical discomfort, Pain associated with toenail onychomycosis may limit the patient’s ability to stand or walk
(5) work and/or social disability
(6) to limit spread to other nails, such as from toenails to fingernails
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