title: The accurate diagnosis of oral lesions in human immunodeficiency virus infection. Impact on medical staging.
abstract: OBJECTIVE
  To compare identification of oral candidiasis (OC) and oral hairy leukoplakia (OHL) by medical examiners and oral/dental examiners and to assess the impact of these diagnoses on the medical staging of the human immunodeficiency virus (HIV).
  
  
  METHODS
  Retrospective analysis of data collected by medical and oral/dental examiners at the baseline examination of a prospective study.
  
  
  METHODS
  Homosexual men and men and women who were parenteral drug users residing in New York City, enrolled in a longitudinal cohort study.
  
  
  METHODS
  A total of 245 individuals participated in this study.
  
  
  METHODS
  The diagnoses of OC and OHL as recorded in the medical and oral/dental charts were analyzed retrospectively for the same medical and oral/dental evaluation visits. The medical staging of HIV infection based on that evaluation was analyzed concomitantly.
  
  
  RESULTS
  Among homosexual men, the oral/dental examiners diagnosed OC in 11% of the individuals and the medical examiners in 4%. In the same cohort, OHL was diagnosed by the oral/dental examiners in 14% of the individuals and by the medical examiners in 8%. Among the parenteral drug users the oral/dental examiners diagnosed OC in 29% of the individuals while the medical examiners made this diagnosis in 11%. In the same cohort, OHL was diagnosed by the oral/dental examiners in 9% of the individuals and by the medical examiners in 2%. The OC and OHL diagnoses affected the medical staging of 12% of the HIV-positive homosexual men and of 22% of the HIV-positive parenteral drug users. Forty percent of the HIV-positive homosexual men and 79% of the HIV-positive parenteral drug users with stage-defining oral lesions were not properly identified by the medical examiners.
  
  
  CONCLUSIONS
  Specific training and a comprehensive oral examination have a significant impact on the diagnoses of OC and OHL, and on the medical staging of individuals with HIV infection.
authors.affiliation: New York City (NY) Department of Health, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Cruz
authors.forename: I B
authors.initials: IB
authors.lastname: Lamster
authors.forename: M D
authors.initials: MD
authors.lastname: Begg
authors.forename: J A
authors.initials: JA
authors.lastname: Phelan
authors.forename: J M
authors.initials: JM
authors.lastname: Gorman
authors.forename: W
authors.initials: W
authors.lastname: el-Sadr
mesh_terms: D002180:Candidiasis, Oral / Q000175:diagnosis* / Q000821:virology; D003141:Communicable Diseases; D004501:Education, Medical; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D017733:Leukoplakia, Hairy / Q000175:diagnosis* / Q000821:virology; D008297:Male; D009909:Oral Health; D010339:Pathology, Oral / Q000193:education; D010808:Physical Examination / Q000592:standards*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013038:Specialization