HIVE MIND - Establishing diagnostic criteria for HIV associated acquired epidermodysplasia verruciformis: an international Delphi study.

BACKGROUND: Acquired epidermodysplasia verruciformis (aEV) is a skin condition caused by increased vulnerability to cutaneous human papillomaviruses. aEV disproportionately affects people who acquire HIV perinatally. There are no accepted diagnostic criteria for aEV. The lack of routine diagnosis has limited research into this condition. There are no community prevalence estimates, no evidence-based treatments and no cohort studies to understand the risk of skin malignancy. Most people with perinatally-acquired HIV, live in low-resource settings without access to specialist skin doctors or skin biopsies. There is therefore a need to develop diagnostic criteria that can be used by non-specialists and are applicable in low-resource settings. AIM: This Delphi study aims reach consensus on screening and diagnostic criteria for HIV-associated aEV which are applicable in both high and low resource settings. METHODS: Modified Delphi methodology will be used to achieve expert consensus. A panel of 20-30 experts with at least 5 years' experience in HIV or dermatology and experience with aEV will be asked to complete a series of surveys. Firstly, they will contribute all possible features of aEV. They will then rate these features in terms of importance. This will be used to guide the creation of draft diagnostic criteria. Panellists will rate their agreement with each criterion and adoption of the criteria as a whole. This will continue until consensus is reached. Consensus is defined a priori as when more than >60% of the panel either agree or strongly agree with each criterion and ≥ 80% of the panel with the adoption of criteria as a whole. EXPECTED OUTCOMES: A screening tool to identify people with possible aEV who warrant further examination.A set of diagnostic criteria that can be applied in real world settings to diagnose aEV. ETHICAL APPROVAL: This study has been approved by the LSHTM Research Ethics Committee (Reference: 33189.).