HIV-related Oral Lesions as Markers of Immuno–suppression

OBJECTIVE: The purpose of this study was to assess the relationship between human immunodeficiency virus - related oral lesions (HIV-ROL) and parameters of immunosuppression (CD4 counts and viral load burden) in adults with HIV/AIDS. METHODS: This cross-sectional study included 248 confirmed HIV-infected adults seen at the AIDS Preventive Initiative for Nigeria (APIN) Centre, Jos, Nigeria. Oral examination was based on the criteria established by the European Community Clearinghouse on oral problems related to HIV infection. Viral load measurement was by quantification of viral RNA in peripheral blood with a minimum detectable level of 400 RNA copies/ml (Amplicor® HIV-1 Monitor Test, version 1.5). CD4 count was determined by the Flowcytometric (Cyflow) method. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value is reported for the association of specific oral lesions and lesion sets with plasma HIV RNA ≥ 20,000 copies/mL and CD4 counts < 200 cells/mm3. RESULTS: The prevalence of HIV-ROL was 44.4%. Oral candidiasis was the most prevalent oral lesion (26.3%) followed by melanotic hyperpigmentation (12.1%), oral hairy leukoplakia (11.7%), and xerostomia (8.5%). The 11 types of HIV-ROLs identified had a PPV for HIV RNA ≥ 20,000 copies/mL of between 76.7 - 100%. Oral hairy leukoplakia alone (PPV = 89.7%) and its concurrent infection with candidiasis (PPV =100%) were associated with high viral load (P<0.05). Significant lesions with high PPVs for CD4 <200 cells/mm3 were as follows: Pseudomembranous candidiasis (96. 2%) erythematous candidiasis (93.8%), angular cheilitis (95.7%) and melanotic hyperpigmentation (86.7%) P<0.05. Linear gingival erythema, Kaposi's sarcoma and aphthous ulcers had a PPV of 100%. CONCLUSION: HIV–related oral lesions can be used as prognostic indices of immuno – suppression in HIV/AIDS patients.