Relationships between CD4+ counts and the presence of oral lesions in human immunodeficiency virus positive women in Nigeria

Abstract

Background:Oral lesions are common findings in human immunodeficiency virus (HIV) infection. The main factor associated with the development of oral lesions is damage to the immune system, specifically loss of CD4+ lymphocytes, which are involved in cell-mediated immunity.Aim:This study was aimed to determine the association of oral lesions in HIV/acquired immune deficiency syndrome women patients with the level of immune suppression as measured by the CD4+ counts.Subjects and Methods:This was a prospective cross-sectional study with a study population of 191 consecutive female patients seen at the University of Benin Teaching Hospital, Nigeria. Ethical clearance was obtained from the institution of study and informed consent was given by every participant. HIV sero-status was determined for all patients. CD4+ count was analyzed for both the HIV+ and HIV– women with oral lesions. The relationships between oral lesions and CD4+ cell count were investigated.Result:About 56.0% (107/191) of the 191 women studied were HIV positive. Age range for the HIV positive women was 18-50 years with a mean age (standard deviation) of 36 (9.2) years. The most common oral lesion observed in the HIV positive women was pseudomembranous candidiasis accounting for 34.6% (37/107). About 68.4% (67/98) of the oral lesions occurred at CD4+ count < 200 cells/ml. Chi-square revealed statistically significant association between the presence of oral lesions and CD4+ count in HIV infected women (P = 0.03).Conclusion:As the CD4+ count was decreasing the presence of oral lesions was increasing in the study. The presence of pseudomembranous candidiasis was found to be significantly associated with CD4+ count level < 200 cells/ml. This association of oral candidiasis with CD4+ cell counts could be used as additional markers of immunosuppression and progression of HIV infection, particularly in a developing country like Nigeria where CD4+ count cannot be determined routinely.

Caries experience by socio-behavioral characteristics in HIV-1 infected and uninfected Ugandan mothers - a multilevel analysis

“…Studies have reported on strong associations between HIV-1 infection and oral mucosal lesions and periodontal disease [8][9][10][11]. Moreover, the prevalence of oral lesions seems to increase with increasing level of immune suppression [12,13].…”

Characterization of oral candidiasis according to antiretroviral treatment status, immunological and virological profiles among HIV infected patients in two health facilities in Yaounde Cameroon: a cross-sectional and analytical study

“…Furthermore, two forms of oral candidiasis were identified in this study: erythematous and pseudomembranous, which are two key prognostic indicators in HIV infection and progression to AIDS [ 28 , 29 ]. Both forms of oral candidiasis were identified mainly among patients with severe immune suppression, which is an important predictor of opportunistic infections among PLHIV [ 30 ].…”

A review of the presentations and treatment of oral pigmentation.

“…2,15 Oral melanotic hyperpigmentation could be used as markers of immunosuppression depicted by CD4+ counts < 200 cells/ml in HIVpositive patients. 16 It is unknown whether structural proteins of HIV can stimulate melanocyte activity directly to upregulate their melanin biosynthesis. It is possible that HIV-associated mucosal hyperpigmentation may fortuitously represent a local protective immune reaction against subclinical oral infections and concomitant inflammatory processes.…”