Co-existence between oral lesions and opportunistic systemic diseases among HIV-infected subjects in Thailand.
BACKGROUND
The purpose of this study was to determine whether any relationship exists between the occurrence of oral lesions and opportunistic systemic diseases among HIV-infected subjects.


METHODS
A cross-sectional analytical study was performed in two hundred and seventy-eight HIV-infected heterosexual persons and intravenous drug users (IVDUs)(230 males and 48 females, aged 16-65 years, mean 31.9 years). Eighty-six HIV-free subjects from the same population were included as controls (61 males and 25 females, aged 17-63 years, mean age 33.1 years). The following information was recorded for each patient: age, gender, risk group and stage of HIV infection, immune status, medication, systemic disease and presence of oral lesions.


RESULTS
Oral candidiasis was the most common oral lesion among HIV-infected individuals (40%), followed by hairy leukoplakia (HL)(26%). The three most common systemic diseases among the subjects were tuberculosis (TB)(53%), cryptococcosis (14%) and Pneumocystis carinii pneumonia (PCP)(11%). Logistic regression analysis revealed a significant association between the occurrence of TB and the presence of oral candidiasis (OR 2.8; 95% CI 1.6-4.8; P < 0.001), and the occurrence of PCP and the presence of HL (OR 2.2; 95% CI 1.1-4.3; P < 0.001). Positive predictive values of any oral lesions and oral candidiasis in predicting TB were 87% (95% CI 73.0-94.6) and 67% (95% CI 51.9-80.0), respectively.


CONCLUSIONS
We concluded that oral candidiasis might be used as a clinical marker for TB, and HL for PCP. Recognition of the lesions by health-care providers may indicate the need for more intensive clinical and laboratory monitoring and possibly initiation of prophylaxis against these opportunistic systemic infections.
Nittayananta
Wipawee
W
Faculty of Dentistry, Prince of Songkla University, Thailand. nwipawee@ratree.psu.ac.th
Chanowanna
Nilnara
N
Winn
Than
T
Silpapojakul
Khachornsakdi
K
Rodklai
Amorn
A
Jaruratanasirikul
Sutep
S
Liewchanpatana
Kriengsak
K
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002180:Candidiasis, Oral / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003453:Cryptococcosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D017733:Leukoplakia, Hairy / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology; D012680:Sensitivity and Specificity; D013785:Thailand / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology