Association of Oral Lesions and Immunosuppression in Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients Not Taking Antiretroviral Therapy in Pakistan

Abstract

Background: Oral lesions, especially oral candidiasis, oral hairy leukoplakia, necrotizing periodontal conditions and variety of other viral and bacterial infections are essentially presented in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients due to low CD4+ count. Aims: This study was designed to determine various oral clinical and cytological mucosal changes seen in HIV/AIDS patients not taking antiretroviral therapy (ART) in Pakistan and their relation to CD4+ lymphocyte count as no study has been reported yet in our country. Materials and Methods: Patients were clinically examined and staged according to World Health Organization (WHO) staging system. Oral smears, from n = 25 patients not taking ART, were prepared and examined microscopically using hematoxylin and eosin, periodic acid-Schiff and Papanicolaou stains. The CD4+ lymphocyte count was determined using flow cytometry. Result: Oral lesions were present in 36% of the patients with chronic periodontitis in 20%, oral candidiasis in 12%, oral pigmentation in 8% and oral ulcers in 4% patients. On cytological examination, fungi were detected in 56% smears. Inflammation was seen in 60% smears, micronuclei in 72%, nuclear atypia in 44% and dysplastic changes in 16% (grade 1 in 12% and grade 2 in 4%) smears. The mean CD4+ lymphocyte count was 338.12 ΁ 127 cells/mm 3 . The CD4+ lymphocyte count was grouped as 350 cells/mm 3 (Group 2). Group 1 comprised of n = 15 while Group 2 had n = 10 patients. Most of the oral lesions were seen in CD4+ Group 1 having low CD4+ count. When the cytopathological variables were compared with WHO clinical stages, a statistically significant association (P < 0.05) was observed in the case of pseudomembranous candidiasis clinically and dysplasia and presence of fungi cytologicaly. Conclusion: This study highlights the importance of oral lesions as a marker of HIV/AIDS progression and immunosuppression as oral lesions were frequent with low CD4+ count especially < 350 cells/mm 3 .