Oral Lesions in 3406 HIV Sero-positive subjects in South India

Methods: A cross sectional study involving 3406 patients attending RAGAS-YRG CARE in Chennai, India over a period of 12 years(1996-2008). Detailed history and clinical findings were recorded using a pre-structured case sheet. Lesions were diagnosed using international criteria. Data entry and analysis was done using SPSS 11.0.5. pvalue ≤ 0.05 was considered significant.

Results: Of the 3406 cases, 2466 (72%) were males, with an age range of 6 months to 73 years, among this 1458 (43%) belong to 31 to 40 years age-group. Heterosexual route was the major route of transmission (90%) . Of the 3406, 672 (20%) were on anti-retroviral therapy(ART), (2 % on ART and 18% on HAART). A total of 2739 (80%) had at least one oral lesion. Gingivitis (71%), pigmentation (21%), periodontitis (16%), pseudomembranous candidiasis (PC) (11%) were the most common oral lesions.

There was a significant difference in the prevalence of gingivitis, periodontitis, PC, oral hairy leukoplakia, angular chelitis (AC) in patients on ART compared to those who were not on ART. (p= 0.008, 0.00, 0.015, 0.005 & 0.002 respectively).

CD4 counts were available for 2264 (67%) cases of which 904 (40%) had CD4 counts ≤ 200 and 1360 (60%) > 200.The prevalence of oral lesions was compared between patients who had CD4 count ≤200 and > 200. There was a significant difference in the occurrence of gingivitis (p =0.000), ulcers (p =0.000), PC (p =0.000), hyperplastic candidiasis (p =0.034), AC (p=0.004) and pigmentation (p =0.000) between the two groups.

Conclusion: Oral lesions are a feature in HIV sero-positive individuals. The prevalence of oral lesions were significantly less in patients who were on ART than those who were not on ART