Accuracy of diagnoses of HIV-related oral lesions by medical clinicians. Findings from the Women's Interagency HIV Study.
OBJECTIVE
To determine if medical clinicians are as accurate as dental clinicians in recognizing diagnostic characteristics of HIV-related oral lesions.


METHODS
In 355 HIV-infected participants at five Women's Interagency HIV Study sites, we paired oral examinations conducted within 7 days of each other by dental and medical clinicians. We used the former as a gold standard against which to evaluate the accuracy of the latter. We assessed the accuracy of the medical clinicians' findings based both on their observations of abnormalities and on their descriptions of these abnormalities.


RESULTS
Dental clinicians diagnosed some oral abnormality in 38% of participants. When "abnormality" was used as the medical clinicians' outcome, sensitivities were 75% for pseudomembranous candidiasis and 58% for erythematous candidiasis, but only 40% for hairy leukoplakia. When a precise description of the abnormality was used as their outcome, sensitivities were 19%, 12% and 20%, respectively.


CONCLUSIONS
Medical clinicians recognize that HIV-related oral abnormalities are present in 40-75% of cases, but less often describe them accurately. Low sensitivity implies that the true associations of specific oral lesions with other HIV phenomena, such as time until AIDS, must be stronger than the literature suggests.
Hilton
J F
JF
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143-0560, USA. joan@biostat.ucsf.edu
Alves
M
M
Anastos
K
K
Canchola
A J
AJ
Cohen
M
M
Delapenha
R
R
Greenspan
D
D
Levine
A
A
MacPhail
L A
LA
Micci
S J
SJ
Mulligan
R
R
Navazesh
M
M
Phelan
J
J
Tsaknis
P
P
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D002140:California / Q000453:epidemiology; D002180:Candidiasis, Oral / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002641:Chicago / Q000453:epidemiology; D003815:Dentists; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D007972:Leukoplakia, Oral / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D009059:Mouth Diseases / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D010820:Physicians; D012680:Sensitivity and Specificity