Prevalence Of HIV-related Oral Lesions Research Articles

Evaluation of oral lesions in HIV seropositive individuals and its correlation with CD4 + T-lymphocytic count

Background and Objectives: Human immunodeficiency virus (HIV) infection is characterized by a gradual reduction in the counts of cluster of differentiation (CD)4 + T-lymphocytes that in turn leads to opportunistic infections and specific neoplastic processes. The introduction of antiretroviral therapy (ART)/highly active ART (HAART) has led to a decrease in the morbidity and mortality associated with HIV infection. The aim of this study is to evaluate the prevalence of HIV-related oral lesions and to correlate these lesions with laboratory parameter such as CD4 + T-lymphocyte count before and after the administration of ART. Materials and Methods: In the present study, a total of 120 patients were evaluated, out of which 79 patients who presented with oral lesions were further assessed for oral lesions and respective CD4 + T-lymphocyte counts. The oral examination was carried out using presumptive criteria by European Community (EC) Clearinghouse and CD4 + T- lymphocyte counts was assessed by flow cytometry. Same group of patients were followed up for next 6 months to determine the changes in the CD4 + T-lymphocyte counts and oral lesions. Results: HIV-related oral lesions were found to be more prevalent in the age group of 31-40 years, with a relatively high frequency of occurrence in male patients. The CD4 + T-lymphocyte count was significantly increased after the administration of ART when compared to that before the administration of ART in all the patients. However, the lesions did not subside completely even after the increase in of CD4 + T-lymphocyte counts. Interpretation and Conclusion: The difference in the prevalence of oral manifestations may be the result of variations in data of the study population such as race, socioeconomic status, sex, drug therapy, genetics, oral habits, and degree of immune suppression and variation in diagnostic criteria.

Oral manifestations of HIV in children receiving anti-retroviral therapy in Hyderabad, India

To assess and compare the oral manifestations of HIV-infected paediatric patients undergoing ART (anti-retroviral therapy) and those not undergoing ART. A cross-sectional study was conducted amongst the 5-12years old, HIV positive children (receiving and not receiving ART) registered at Nireekshana ART centre, Hyderabad and HIV negative children enrolled in a nearby school. HIV-related oral lesions were diagnosed according to WHO criteria. Information on age, gender, place of residence (urban/rural), socio-economic status, duration of HIV infection, duration of ART therapy, use of traditional medicine, presence of HIV-related systemic disease was recorded. CD4+ cell count was also determined for each subject. Chi-square test, stepwise multiple linear and logistic regression were used for statistical analysis. For all tests, confidence interval and p value were set at 95% and p≤0.05, respectively. Twelve percent and 21.3% of the study participants were on short-term and long-term ART (Group I), respectively. A greater proportion of HIV patients receiving treatment had CD4+ cell counts of more than 750cells/mm(3). Nearly 81.3% of HIV patients receiving long-term therapy did not have any oral lesions. Around half of the participants not receiving treatment suffered from HIV-related oral lesions. The best predictors for presence of oral lesions were socio-economic status, group (ART treatment), duration of HIV infection and CD4+ cell count. The results of the present study demonstrated that ART proved to be effective in reducing the prevalence of HIV-related oral lesions.

Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

Background:The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART.Materials and Methods:All patients aged 15 years and below attending the Infectious Disease Clinic of Aminu Kano Teaching Hospital with a diagnosis of HIV were consecutively examined in a cross-sectional study over a 2-year period. Information was obtained by history, physical examinations, HIV testing, and enumeration of CD+ T cells. The results are presented. A P-value of <0.05 was considered significant.Results:A total of 105 children comprising 63 males and 42 female who met the inclusion criteria participated in the study, mean age in months was 53.3±42.2, with a mean of 3.4±2.2 for male and 2.8±1.8 for female respectively. Oral lesions occurred in 61.9% of the children Overall, 22 (21.0%) had at least one oral lesion, 43 (41.0%) had multiple lesion. The most common lesion was oral candidiasis (79.1%). The angular cheilitis (43.8%) variant was most frequent. The mean CD4 counts were 1138 cells/mm3, 913 cells/mm3 and 629 cells/mm3 for those without oral lesion, with single lesion and multiple oral lesions respectively. These differences were not statistically significant (ANOVA: F=0.185, df=2, 80, 82, P=0.831. Patients on HAART comprised about 61.9% and these were found to have reduced risk for development of such oral lesions as angular cheilitis (OR=0.76; 95% CI=0.56-1.02; P=0.03), pseudomembranous candidiasis (OR=0.71; 95% CI=0.54-0.94; P=0.024) and HIV-gingivitis (OR=0.59; 95% CI=0.46-0.75; P=0.001). HAART had some beneficial but insignificant effect on development of HIV-periodonttitis (OR=0.60; 95% CI=0.51-0.70; P=0.09). The chances of occurrence of other oral lesions were not significantly reduced by HAART (Kaposi sarcoma, OR=1.24; 95% CI=0.31-5.01; P=0.47, erythematous candidiasis, OR=1.13; 95% CI=0.62-2.06).Conclusion:HIV-related Oral lesions are frequently seen in HIV-infected Nigerian children. Paediatric patients receiving HAART had significantly lower prevalence of oral lesions, particularly oral candidiasis and HIV-gingivitis.

The impact of Highly Active Antiretroviral Therapy (HAART) on the clinical features of HIV - related oral lesions in Nigeria

BackgroundThis study aimed to determine the therapeutic effects of highly active anti-retroviral therapy (HAART) on the clinical presentations of HIV related oral lesions (HIV-ROLs) in an adult Nigerian population.MethodsA 5 month prospective study on HAART naïve HIV positive adults recruited into the HAART program of an AIDS referral centre. HIV-ROLs were diagnosed clinically by the EEC Clearinghouse on oral problems related to HIV infection. Baseline clinical features of HIV-ROLs was documented by clinical photographs using SONY® 5.2 M Cybershot digital camera. Post HAART monthly review was conducted using clinical photographs.ResultsA total of 142 patients were seen. Age range was 19 - 75 years. Mean age was 35.6 ± 10.5 (SD). Eighty (56.3%) were females. Prevalence of HIV-ROLs was 43.7%. Oral candidiasis (22.4%) was the most prevalent HIV-ROL. 114 (83.2%) patients had clinical AIDS at presentation (CDC 1993). 89.4% were placed on Tenofovir/Emtricitabine +`Nevirapine, 9.9% on Tenofovir/Emtricitabine + Efavirenz. There was strong decline in the clinical features of oral candidiasis from a month of commencing HAART. Oral hairy leukoplakia was slow in responding to HAART. Parotid gland enlargement, melanotic hyperpigmentation and Kaposi's sarcoma were more persistent and had slower response to HAART. There was no clinical change noticed in linear gingival erythema.ConclusionHAART has different clinical effects on HIV related oral lesions depending on the size, duration of treatment and etiology of the lesions. HIV-ROLs of fungal origin have the fastest response to HAART. These lesions alongside immunologic parameters can be used as indicators of success or failure of antiretroviral therapy.

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This study's intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5%. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

Oral manifestations of HIV infection in adult patients from the province of Sancti Spiritus, Cuba

Studies on the prevalence of HIV-related oral lesions (HIV-OL) have shown great variations among different countries. The aim of this study was to describe the prevalence of HIV-OL in adults infected with HIV in the province of Sancti Spiritus, Cuba, and to determine the factors associated with the presence of HIV-OL. A cross-sectional observational study was performed between November 2006 and August 2007 at the Hospital General Universitario 'Camilo Cienfuegos', Sancti Spiritus. One hundred and fifty-four HIV-infected patients were included. Patients were examined and interviewed by a periodontal specialist. Diagnosis of HIV-OL was based on clinical criteria. Demographical, clinical and laboratory data were obtained. Independent association of each factor with HIV-OL was assessed by logistic regression modelling. The prevalence of HIV-OL was 40.9%. The commonest manifestation was oral hairy leucoplakia (n = 19; 12.3%); oral candidiasis (n = 17; 11%); herpes simplex virus infection (n = 11; 7.4%); and aphthous ulcer (n = 9; 5.8%). Principal factors associated with the presence of HIV-OL were CD4(+) lymphocytes <500 cells/mm(3) (OR: 2.06; 95% CI: 1.019-4.195) and smoking (OR: 2.03 CI: 1.037-3.982). This study described the prevalence of HIV-OL in 154 HIV-infected patients which represent about 80% of those known to be infected in the province of Sancti Spiritus. The prevalence of HIV-OL was lower than those reported from developing countries. Oral hairy leucoplakia and oral candidiasis were the most prevalent HIV-OL. Smoking and CD4(+) cells count <500 cells/mm(3) were the two factors independently associated with the presence of HIV-OL.

Oral manifesto of HIV/AIDS in Plateau state indigenes, Nigeria

To investigate the prevalence of oral manifestations of HIV/AIDS involving HIV positive Plateau State indigenous adults attending a Special Treatment Clinic serving referred cases and in-patient cases hospitalized in the Medical wards in JUTH, Jos. A cross-sectional study. A total of 261 patients confirmed for HIV infection were examined. The age range was 17 - 80 years, mean = 35.6 +/- 9.27 (SD). 59.4% were females and 40.6% were males. Oral lesions attributable to HIV/ AIDS infection were found in 109 (41.8%) patients, 38 (34.9%) of these patients had multiple lesions. Oral lesions were diagnosed more frequently in women (59.6%) than in men (p=0.945). Oral candidiasis was the most common presentation (35.7%) with pseudomembraneous candidiasis (23%) and angular cheilitis (10%) being the most common variants. All the cases of erythematous candidiasis (n=7) were exclusively seen in the female population. Oral hairy leukoplakia and xerostomia were present in 4.6% and 3.8% of cases respectively. Kaposi's Sarcoma was in 5 (1.9%) patients. The prevalence of HIV-related oral lesions (HIV-ROL) in a hospital based adult population of Plateau State indigenes in Jos is 41.8%. Oral Candidiasis is the most common HIV-ROL detected and this agrees with most reported findings.

Prevalence of HIV-related oral lesions in Nigerian women

Human immunodeficiency virus (HIV) infection affects an increasing number of women throughout the world. Oral lesions are among the earliest clinical manifestations of HIV infection and are associated with its progression. We describe the oral manifestations of HIV/AIDS in Nigerian women and its clinical correlates. Nigerian women with HIV/AIDS were examined for the presence of oral lesions attributable to HIV/AIDS. These lesions were diagnosed clinically, according to the criteria established by the European Community Clearinghouse (ECC) on oral problems related to HIV infection. Two hundred and sixty-nine seropositive women were examined with a range of 17-60 years (mean of 32.4 years < 8.09). The age group of 21 30 years was the worst affected (n = 125, 46.5%). Of these patients, 109 (40.5%) were married, 67 (24.9%) were single while 47 (17.5%) had multiple sexual partners. One hundred and eighteen (43.9%) had at least an oral lesion associated with HIV/AIDS. The most common was oral candidiasis, which was present in 98 (36.4%) patients. Pseudomembraneous candidiasis (n = 66, 24.5%) and angular cheilitis (n = 23, 8.6%) were the commonest variants seen. The former was the only lesion significantly associated with the clinical stage of the infection (p = 0.002) while necrotizing gingivitis, linear gingival erythema and angular cheilitis were associated with the age of the patients (p < 0.05). Oral manifestations are common features of HIV infection among Nigerian women. Oral candidiasis (OC) was the most notable oral lesion associated with HIV/AIDS. It may be a useful clinical indicator of early immune dysfunction mediated by HIV.

Oral manifestations in HIV/AIDS infected patients from India

To assess types and prevalence of HIV-related oral lesions among HIV-infected individuals in south India and to correlate common oral findings with co-morbidities, gender, age and medication. One hundred and one patients with HIV infection or AIDS at infectious diseases units of Attavar Hospital, Mangalore, and medical wards of Kasturba Medical College, Manipal, were selected. Sociodemographic information was obtained using a structured questionnaire. Oral lesions were diagnosed according to the presumptive criteria of EEC-Clearinghouse Classification. Clinical history was retrieved from patient's medical records. Erythematous candidiasis (44.5%), melanotic hyperpigmentaion (34.6%) and xerostomia (29.7%) were among the most common oral manifestations. A significant association was found between oral candidiasis and advanced immunosuppression (P < 0.05). Oral hairy leukoplakia (OHL) was predominant in individuals <35 years (P < 0.05). Melanotic hyperpigmentation was significantly associated with highly active antiretroviral therapy (P < 0.05). OHL was more frequent in patients with HIV-associated tuberculosis. Linear gingival erythema was more predominant in females. Oral hairy leukoplakia showed a positive relationship with patients younger than 35 years. Oral candidiasis can act as a marker for immunosuppression. Angular cheilitis was predominant in the symptomatic stage.

HIV-Related Oral Lesions, Demographic Factors, Clinical Staging and Anti-Retroviral Use

The aim of the present study was to compare the prevalence of HIV-related oral lesions (HIV-OL) between two health centers for HIV in Mexico City and to analyze the factors that, in addition to combined antiretroviral therapy (CART) and low CD4(+), may be associated with possible differences in prevalence. A cross-sectional observational study was performed between January 2000 and February 2003 at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), a specialized referral center for HIV/AIDS patients and the Clínica Especializada Condesa (CEC), a primary care center for HIV-infected individuals without social security insurance. A consecutive sample of HIV-infected individuals had an oral examination based on established clinical criteria. Demographic, clinical and laboratory data were obtained. Independent association of each factor with specific HIV-OL was assessed by logistic regression modeling. Eight hundred fifty individuals were examined (INCMNSZ: 479; CEC: 371). Hairy leukoplakia (HL), periodontal disease (PD) and Kaposi's sarcoma (KS) were independently associated with the study site [odds ratio (OR) = 1.7 (95% confidence interval (CI): 1.1-2.4), OR = 4.2 (95% CI: 1.3-13), OR = 10.1 (95% CI: 2.7-38.2), respectively], being more frequent in CEC patients. HL was independently associated with men having sex with men OR = 1.7 (95% CI: 1.1-2.8). All HIV-OL were independently associated with CD4(+) counts and, with the exception of PD and KS, with time under CART. The present comparative study showed that several factors were associated with a difference in prevalence of oral lesions found in two AIDS clinics located in Mexico City. Severe immune suppression, CART duration and the study site were associated with HIV-OL. Further investigation into factors such as socioeconomic determinants associated with HIV-OL is warranted.

Prevalence of oral lesions in Mexican children with perinatally acquired HIV: association with immunologic status, viral load, and gender.

It has been proposed that HIV-related oral lesions (HIV-ROL) have a significant diagnostic and prognostic value for human immunodeficiency virus (HIV) infection in adult patients. However, in HIV-infected children, the relation between HIV-ROL and immune and virologic status is not well established. The principal objective of this paper is to assess the prevalence of HIV-related oral lesions (HIV-ROL) in Mexican HIV-infected children in relation to their immunologic status, viral load, and gender. Forty-eight HIV-infected children from Immunodeficiency Clinic, Child's Hospital of México, México City, were examined for oral pathology. The data obtained from medical records were: name, gender, age, route of infection, CD4 lymphocytes cells count/mL, HIV-1-RNA level of copies/mL (viral load), and type and time of treatment. The prevalence of HIV-ROL was 29.2%. Oral candidosis was the most prevalent oral lesion (20.8%) followed by periodontal and gingival disease (4.2%), herpes simplex (2.1%), and parotid enlargement (2.1%). There was no association between the prevalence of HIV-ROL and gender, immunological status, or viral load. The most frequent clinical form of oral candidosis was erythematous candidosis (12.5%, N = 6). Our results do not suggest a direct relationship between prevalence of HIV-ROL, severe immunodepression, and/or viral load > 100000 copies in this population.

Gender differences in human immunodeficiency virus–related oral lesions: An Italian study

Objective: The purpose of this study was to investigate the relationship between oral lesions and gender, age, CD4+ cell count, human immunodeficiency virus-1 (HIV-1) viral load, antiretroviral therapy, and route of transmission in a group of HIV-infected (HIV+) persons from the Mediterranean region. Study Design: The participants in this study were HIV+ adults who sought dental care between January 1999 and June 1999 in the Department of Oral Medicine (University of Palermo, Italy). Results: One hundred thirty-six HIV+ adults came in for an initial oral examination. Their mean age was 35.2 years (SD ± 7.97), and 33% were women. Their mean CD4+ cell count was 325.3 × 106 /L (SD ± 225.8), and their HIV-1 viral load was 39,168.3 copies/mL (SD ± 144,256.1). Oral lesions were found in 47% of the study group, as well as in 56.5% of women (n = 46) versus 45.5% of men (n = 90; P = .05). Oral candidiasis was the most common disease; it is significantly associated with women (P = .004), CD4+ cell count (P = .005), and HIV-1 viral load (P = .0003). No significant relationships were found between any types of oral lesions and age, antiretroviral therapy, or route of transmission (P > .2). Conclusion: The prevalence of HIV-related oral lesions was significantly higher in women than in men, especially for oral candidiasis, the most common lesion observed related to immune status and HIV-1 viral load.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:546-51)

HIV infection: oral lesions, CD4+ cell count and viral load in an Italian study population.

The aims of this study were to assess types and prevalence of HIV-related oral lesions and to correlate these lesions to the main laboratory parameters such as CD4+ cell count and plasma HIV-RNA. The study population consisted of 104 consecutive HIV+ patients living in Sicily (M=67, 64.4%; F=37, 35.6%; median age=35 years). CD4+ cell count and viral load were measured within 24 h of oral examination. Data were managed and analysed by Epi-Info 6.0. HIV-related oral lesions, as classified by the EC-Clearinghouse, were diagnosed in 35.6% of patients: these were of the Strongly Associated (SA) type in 22.1%, the Less Common Associated (LCA) type in 12.5%, and the Lesions Seen in HIV Infection (LS) type in 3.8%. CD4+ cell counts <200 x 10(6)/l were significantly associated only with SA lesions (P=0.03); median values of CD4+ cell count were also significantly correlated (P=0.02). Viral load, expressed both by median values of copies/ml (P=0.0001) and log10 copies/ml (P=0.0003), was significantly associated only with SA lesions. Treatment failure was significantly correlated to SA lesions (P=0.04). Besides the confirmed correlation with CD4 depletion, the strong association with a high level of viral load could make SA oral lesions a useful tool for identifying progression of HIV infection and could be of value in monitoring antiretroviral therapy.

Oral manifestations of HIV infection by gender and transmission category in Mexico City.

A cross-sectional analysis was conducted in Mexico City from September 1989 to March 1996, to determine the prevalence of HIV-related oral manifestations by gender and route of HIV transmission. The diagnosis of HIV-associated oral lesions was based on preestablished criteria. For the statistical analysis chi-squared and Fisher's exact tests were used where appropriate. Odds ratios were calculated as estimates of the relative risks. Control of confounding factors was performed by logistic regression models. Oral lesions were present in 75% of 436 HIV+ patients. Hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis and oral ulcers were frequently found. Patients who contracted HIV through blood transfusion were more likely to present erythematous candidosis (P=0.005) than subjects who acquired HIV through sexual transmission. Oral ulcers were seen only in men (P=0.02) and in individuals who contracted HIV through sexual transmission (P=0.02). This study brings valuable data in regard to differences in the type and prevalence of HIV-related oral lesions by gender and the risk categories analysed, particularly blood transfusion.

The prevalence of oral lesions in HIV-infected homosexual and bisexual men

To establish the prevalence of HIV-related oral lesions, we performed oral examinations of members of three San Francisco epidemiological cohorts of homosexual and bisexual men over a 3-year period. Hairy leukoplakia, pseudomembranous and erythematous candidiasis, angular cheilitis, Kaposi's sarcoma, and oral ulcers were more common in HIV-infected subjects than in HIV-negative subjects. Among HIV-infected individuals, hairy leukoplakia was the most common lesion [20.4%, 95% confidence interval (CI) 17.5-23.3%] and pseudomembranous candidiasis was the next most common (5.8%, 95% CI 4.1-7.5%). Hairy leukoplakia, pseudomembranous candidiasis, angular cheilitis and Kaposi's sarcoma were significantly more common in patients with lower CD4 lymphocyte counts (P less than 0.05). The prevalence of erythematous candidiasis and Kaposi's sarcoma increased during the 3-year period. Careful oral examinations may identify infected patients and provide suggestive information concerning their immune status.