Oral manifestations as predictors of immune suppression in a HIV-/AIDS-infected population in south India.
The objectives of the study are to evaluate the relationship between common HIV-related oral lesions and absolute CD4+ count, age, gender, and medication used and to assess the sensitivity, specificity, positive and negative predictive value of oral manifestations for low absolute CD4+ counts. HIV-positive patients, 200, from south India were selected, whose absolute CD4+ counts were determined within 2 weeks of oral examination. Sociodemographic data was obtained using a structured questionnaire. Oral manifestations were diagnosed according to presumptive criteria of EEC-clearinghouse classification (1993). Four or more concurrent oral lesions were statistically significant with low CD4+ counts <200 cells/mm3 (P = 0.005). The highest and lowest mean CD4+ cell counts were seen in individuals with linear gingival erythema (LGE; 172.5 cells/mm(3)) and pseudomembranous candidiasis (PC; 87 cells/mm(3)), respectively. Smoking, age (<35 years), and males had a positive association with oral hairy leukoplakia (OHL; P < 0.05). Patients with CD4+ counts < 200 cells/mm(3) were associated with 15 times greater risk of PC and four times at greater risk for occurrence of any oral manifestation. Concurrent oral manifestations (>or=4) were good predictors (80-100%) of severe immune suppression. In most resource poor countries where facilities for undertaking CD4+ counts are not available, the presence of concurrent oral manifestations may be used as an indicator of deteriorating immune status.
Sharma
Gaurav
G
Department of Oral Medicine and Radiology, ITS-CDSR, Murad nagar, Ghaziabad, Uttar Pradesh, India. drgaurav7479@rediffmail.com
Pai
Keerthilatha M
KM
Setty
Suhas
S
Ramapuram
John T
JT
Nagpal
Archna
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking; D000890:Anti-Infective Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000150:complications / Q000276:immunology*; D004890:Erythema / Q000150:complications / Q000276:immunology; D005260:Female; D005882:Gingival Diseases / Q000150:complications / Q000276:immunology; D015658:HIV Infections / Q000150:complications / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D007194:India; D017733:Leukoplakia, Hairy / Q000150:complications / Q000276:immunology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D055815:Young Adult
D000890:Anti-Infective Agents