title: Synchronous kinetics of CD4+ lymphocytes and viral load before the onset of oral candidosis and hairy leukoplakia in a cohort of Mexican HIV-infected patients.
abstract: An observational, prospective, longitudinal cohort study was performed at the AIDS Clinic of a tertiary care institution in Mexico City to determine the association of viral load (VL) and CD4+ lymphocyte kinetics with the development of oral candidosis (OC) and hairy leukoplakia (HL). Participants were HIV-infected adult subjects, without a history of or current OC or HL, not receiving HAART. Oral examinations were performed at baseline and every month for evidence of OC or HL; CD4+ and VL determinations were done at baseline, at 6-month intervals, when oral lesions were detected, and 2 months later. Affected subjects (OL group) by OC or HL had clinical intervals defined before (antecedent), during (concurrent), and after their development. In the nonaffected individuals (NA group), 6-month intervals were determined. Differences (changes) along the clinical and study intervals were calculated for CD4+ and VL. The median study time was 178 (range: 31-924) days; 99 patients were included. The 2-year cumulative incidence of either oral lesion was 54% (49.5% for OC and 33.2% for HL). In the OL group (31 patients) a progressive and continuous decrease of CD4+ was found in the antecedent interval followed by a significant increase in VL in the concurrent period. The NA group showed a significant fall in CD4+ by semester 3, without a significant rise of VL in the following semester. The effect of CD4+ remained significant in a multivariate analysis. This study has shown that the onset of OC and/or HL is heralded by the sequence of a sustained reduction of CD4+, followed by a sharp increase of VL. In the multivariate analysis, the decrease in CD4+ lymphocytes appeared to be the predominant factor predicting the appearance of these oral lesions. Their potential use as markers of a recent change in the immunologic and virologic status of HIV-infected individuals is emphasized.
authors.affiliation: Universidad Autónoma Metropolitana-Xochimilco, México D.F. raval1863@correo.xoc.uam.mx
authors.forename: Velia
authors.initials: V
authors.lastname: Ramírez-Amador
authors.forename: Sergio
authors.initials: S
authors.lastname: Ponce-De-León
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra-Madero
authors.forename: Luis
authors.initials: L
authors.lastname: Soto-Ramírez
authors.forename: Lilly
authors.initials: L
authors.lastname: Esquivel-Pedraza
authors.forename: Gabriela
authors.initials: G
authors.lastname: Anaya-Saavedra
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000209:etiology / Q000276:immunology; D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D002180:Candidiasis, Oral / Q000209:etiology* / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D017733:Leukoplakia, Hairy / Q000209:etiology* / Q000276:immunology; D008297:Male; D008800:Mexico; D011446:Prospective Studies; D019562:Viral Load