Predictors and prognostic value of oral hairy leukoplakia and oral candidiasis in South African HIV-infected patients.
BACKGROUND
Oral hairy leukoplakia and oral candidiasis diseases (OHL/OC) are common clinical manifestations of HIV/AIDS. Sparse literature exists from resource-limited countries on their incidence and impact on HIV-infected patients.


OBJECTIVE
To determine the predictors and prognosis of OHL/OC in HIV-infected patients.


METHODS
Patients were drawn from a cohort established in 1992 and prospectively followed until 1997 in the adult HIV clinics, University of Cape Town. Cox hazards regression models were fitted to determine the predictors of OHL/OC, and the association between OHL/OC and progression to AIDS and death.


RESULTS
218 patients presenting with OHL/OC at their initial clinic visit were excluded. 205/772 patients developed OHL/OC (27.8 cases/100 years). White ethnicity (hazard ratio [HR] = 1.73, 95% CI 1.23-2.33), CD4+ count < 200 cells/(L (HR = 2.55, 95% CI 1.89-3.45), total lymphocyte count < 1250 cells/(L (HR = 1.72, 95% CI 1.28-2.31) and WHO stage 3 or 4 (HR = 2.61, 95% CI = 1.93-3.53) where variables predictive of increased hazard to developing OHL/OC. OHL/OC were independently associated with hazard of AIDS (HR = 3.65, 95% CI 1.89-6.69) and death (HR = 2.12, 95% CI 1.47-4.34).


CONCLUSIONS
The presence of OHL/OC in HIV-infected patients provides important prognostic information, and can be used as a cost-effective tool for screening patients in therapeutic interventions in resource-limited settings.
Badri
M
M
Infectious Diseases Unit, Department of Medicine, University of Cape Town.
Maartens
G
G
Wood
R
R
D017088:AIDS-Related Opportunistic Infections / Q000503:physiopathology*; D000163:Acquired Immunodeficiency Syndrome / Q000145:classification / Q000503:physiopathology; D000328:Adult; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000503:physiopathology*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015658:HIV Infections / Q000145:classification / Q000503:physiopathology*; D006801:Humans; D017733:Leukoplakia, Hairy / Q000503:physiopathology*; D018655:Lymphocyte Count; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D013019:South Africa; D044465:White People