ORAL LESIONS AS A MARKER OF HIV/AIDS PROGRESSION- A CYTOLOGICAL STUDY

Objectives: Inflammatory to cancerous lesions of the oral mucosa are more frequently seen in patients with HIV/AIDS having low CD4+ lymphocyte count (<200 cells/mm³). No study has ever been reported from Pakistan to highlight these lesions that are now considered globally as the clinical markers of disease progression and immunosuppression. This study was therefore carried out to describe the clinico-cytological changes in the oral mucosa of HIV/AIDS patients and to relate these lesions with the CD4+ lymphocyte count.
Methods: After detailed clinical history and oral examination, smears from the buccal mucosa of n=60 patients were prepared and examined microscopically using routine and special stains (Haematoxylin & Eosin, Papanicolaou, Periodic Acid Schiff’s and Gomori`s methenamine sliver). The CD4+ lymphocyte count was determined using flow cytometry. The HIV/AIDS patients were clinically staged according to the WHO criteria.
Results: Varied oral lesions were present in 52% of the patients including pseudomembranous candidiasis (8%), xerostomia (3.3%), chronic periodontitis (23%), mucositis (1.7%), oral hairy leukoplakia (1.7%), oral mucosal pigmentation (40%), wart (1.7%) and ulcers (5%). On cytological examination, mild to marked inflammation (63.3%), candida and non candidal fungi (51.6%), micronuclei (62%), nuclear atypia (40%) and dysplastic changes (16.6%) in squamous epithelial cells were seen. Frequency of these cytological changes increased significantly (p=0.00 to 0.007) with the increasing WHO clinical stage. The CD4+ lymphocyte count was categorized as Group 1 (<350 cells/mm³⁾ and Group 2 (>350 cells/mm³) comprising of n=37 and n=23 patients respectively. Most (75%) of the oral lesions were seen in Group1 patients (p=0.001).
Conclusions: Holding a strong relationship with low CD4+ lymphocyte count, oral mucosal lesions can be used as non-invasive and cost effective clinical markers for assessment of immunosuppression and disease progression in comparison to much expensive repeated CD4 flow cytometry for the HIV /AIDS patients of resource constrained countries like Pakistan.