Oral manifestations as predictors of immune suppression in a HIV-/AIDS-infected population in south India

Abstract

The objectives of the study are to evaluate the relationship between common HIV-related oral lesions and absolute CD4+ count, age, gender, and medication used and to assess the sensitivity, specificity, positive and negative predictive value of oral manifestations for low absolute CD4+ counts. HIV-positive patients, 200, from south India were selected, whose absolute CD4+ counts were determined within 2 weeks of oral examination. Sociodemographic data was obtained using a structured questionnaire. Oral manifestations were diagnosed according to presumptive criteria of EEC-clearinghouse classification (1993). Four or more concurrent oral lesions were statistically significant with low CD4+ counts <200 cells/mm3 (P = 0.005). The highest and lowest mean CD4+ cell counts were seen in individuals with linear gingival erythema (LGE; 172.5 cells/mm(3)) and pseudomembranous candidiasis (PC; 87 cells/mm(3)), respectively. Smoking, age (<35 years), and males had a positive association with oral hairy leukoplakia (OHL; P < 0.05). Patients with CD4+ counts < 200 cells/mm(3) were associated with 15 times greater risk of PC and four times at greater risk for occurrence of any oral manifestation. Concurrent oral manifestations (>or=4) were good predictors (80-100%) of severe immune suppression. In most resource poor countries where facilities for undertaking CD4+ counts are not available, the presence of concurrent oral manifestations may be used as an indicator of deteriorating immune status.

Prevalence of oral lesions in HIV infected adult population of Mangalore, Karnataka, India

“…Oral candidiasis was the common finding with Erythematous candidiasis showing prevalence in 48% of the patients which is in agreement with a previous study done in the same region by Sharma and colleagues [12].…”

“…hyperpigmentation (32.8%), linear gingival erythema (16.8%), hairy leukoplakia (15.2%), angular cheilitis (12.8%), and pseudomembranous candidiasis (12%) was found to be consistent with the previous studies [12][13][14].…”

“…The number of lesions increased with increased degree of immunosuppression as has been pointed out by the study done by Sharma et al [12]. The oral lesions were studied according to the immunosuppression staging done by WHO in 2007 so that the preventive measures instituted for the oral health can be correlated to the WHO treatment guidelines in different stages of infection.…”

Manifestações orais associadas ao HIV após 30 anos de epidemia no Brasil

“…Em locais onde estes testes laboratoriais não estão disponíveis, a identificação de sinais clínicos que indiquem a progressão da doença possui grande valor (Ranganathan et al, 2000;Birnbaum et al, 2002 A candidíase oral foi associada a níveis baixos de CD4 (<200) (Chidzonga et al, 2008) e a carga viral alta Sharma et al, 2009). A CP apresentou correlação com a progressão da doença (Moniaci et al, 1990;Palmer et al, 1996;Kerdpon et al, 2004;Sharma et al, 2009). …”

“…De acordo com descrito na literatura, a presença de lesões orais esteve associada a CD4 <200 (p=0,002) (Barr et al, 1992;Glick et al, 1994;Patton et al, 2000;Ramírez-Amador et al, 2003;Kerdpon el al., 2004;Sharma et al, 2009;Ferreira et al, 2009) e CV >10.000 (p=0,05) Ramírez-Amador et al, 2003;Ferreira et al, 2007). Porém, quando se analisa a presença de lesões orais em outras faixas de CV em log, apesar de estarem mais presentes em pacientes com CV acima de 100.000 (log5), não houve significância estatística (p=0,06).…”