The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients

Abstract

In developing countries, the variations in the clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions over time, and the possible effects of antiretroviral therapy, have not been described. In this study we evaluate the clinical spectrum of oral lesions in a series of HIV-infected patients when first examined at the acquired immunodeficiency syndrome (AIDS) clinic of a tertiary care institution in Mexico City, Mexico, and the changes observed over 12 years. All HIV-infected adult patients had an oral examination performed by specialists in oral pathology and medicine who used established clinical diagnostic criteria for oral lesions. Four periods were defined according to the evolving pattern of antiretroviral use: the first 2 were before the introduction of highly active antiretroviral therapy (HAART) and the last 2 were during more established use of HAART. For the statistical analysis the chi-square test for contingency tables and the chi-square test for trend were utilized. For dimensional variables, except age, the Kruskal-Wallis or Mann-Whitney rank sum tests were used when applicable and trend was tested with the Spearman correlation coefficient. Age was tested through analysis of variance (ANOVA) and linear regression analysis. Alpha value was set at p = 0.05 for each test. In the 12-year study, 1,000 HIV-infected patients were included (87.9% male). At the baseline examination, oral lesions strongly associated with HIV were present in 47.1% of HIV-infected patients. Oral candidosis (31.6%), hairy leukoplakia (22.6%), erythematous candidosis (21.0%), and pseudomembranous candidosis (15.8%) were the most frequent lesions. Oral Kaposi sarcoma (2.3%), HIV-associated periodontal disease (1.7%), and oral non-Hodgkin lymphoma (0.1%) were less frequent. HIV-related oral lesions decreased systematically-by half during the course of the 4 study periods (p < 0.001). Except for Kaposi sarcoma, all oral lesions strongly associated with HIV showed a trend to decrease significantly during the study period. No apparent variation in the occurrence of salivary gland disease or human papillomavirus-associated oral lesions was found. A significant trend to a lower prevalence was observed in the group of patients who were already taking antiretroviral therapy, non-HAART and HAART (p < 0.001 and p = 0.004, respectively). Only a discrete reduction, barely significant, was noted among untreated patients (p = 0.060). By Period IV (1999-2001), those who received HAART showed the lowest prevalence of oral lesions strongly associated with HIV (p < 0.001). Patients with oral lesions strongly associated with HIV had significantly lower median CD4+ counts and higher viral loads than those without oral lesions strongly associated with HIV (p < 0.001 and p = 0.005, respectively). When CD4+ counts were correlated with prevalence of oral candidosis, a consistently negative association was found; this association prevailed even after the study group was partitioned according to period. In this selected cohort of 1,000...

OralCandidaIsolates Colonizing or Infecting Human Immunodeficiency Virus-Infected and Healthy Persons in Mexico

“…Overall, yeasts were isolated from 59.9% of the subjects; of these, 32.7% presented with oral lesions by yeasts. This rate coincides with the 31.6% prevalence reported for oral candidiasis in Mexico during the last 12 years in HIV-infected patients (19). Moreover, only 12% of children infected with HIV/AIDS with oral colonization suffered from candidiasis.…”

Oral lesions and conditions associated with human immunodeficiency virus infection in 300 south Indian patients

“…2,14,[25][26][27][28][29] 60.4% of the patients with candidiasis were smokers and all of them were males. OC was highly associated with smoking, being 1.7 times more frequent in persons who smoke than in non-smokers (P <0.05).…”

Oral Health-Related Quality of Life Among People Living with HIV/AIDS

“…Prevalence of oral lesions has been shown to be significantly higher in individuals with a CD4+ count less than 200 cells/mm 3 and a viral load greater than 3000 copies/mL (Bravo et al, 2006;Greenspan et al, 2000;Tappuni & Fleming, 2001). The importance of oral lesions as clinical indicators of HIV infections and markers of clinical progression to AIDS has been demonstrated in many studies that reported their association with CD4+ depletion and high viral load (Bravo et al, 2006;Campo et al, 2002;Chattopadhyay et al, 2005;Glick et al, 1994;Greenspan et al, 2000;Patton, 2000;Ramírez-Amador et al, 2003;Shiboski et al, 2001). A comprehensive review of epidemiologic studies on HIV-related oral lesions reported from developed and developing countries over more than a decade, encompassing the pre-HAART and early-HAART period from 1986 to 2000, revealed oral candidiasis as the most common lesion found in all ages across the world (Patton et al, 2002).…”

“…The introduction of HAART has not only resulted in significant decline in mortality associated with HIV across the world, significant reduction was also seen in the prevalence of most AIDS-defining illnesses and opportunistic infections (Buchacz et al, 2010;Kaplan et al, 2000;Mocroft et al, 2004). Similarly, there has been a downward trend in the prevalence of oral opportunistic lesions in response to the use of HAART (Franceschi et al, 2008;Patton et al, 2000;Ramírez-Amador et al, 2003;Shiboski, 2002;Yang et al, 2010). Notable reduction was reported in the prevalence of two most common HIV-associated lesions, oral candidiasis and hairy leukoplakia (Eyeson et al, 2002;Nicolatou-Galitis et al, 2004;Patton et al, 2000;Ramírez-Amador et al, 2003).…”

“…Similarly, there has been a downward trend in the prevalence of oral opportunistic lesions in response to the use of HAART (Franceschi et al, 2008;Patton et al, 2000;Ramírez-Amador et al, 2003;Shiboski, 2002;Yang et al, 2010). Notable reduction was reported in the prevalence of two most common HIV-associated lesions, oral candidiasis and hairy leukoplakia (Eyeson et al, 2002;Nicolatou-Galitis et al, 2004;Patton et al, 2000;Ramírez-Amador et al, 2003). Despite the great success of HAART, the therapy remains an expensive option that may be unaffordable to many, especially those living in low-income countries (WHO et al, 2009).…”