Impact of PI and NNRTI HAART-based therapy on oral lesions of Brazilian HIV-infected patients.
BACKGROUND
The incidence of oral lesions related to human immunodeficiency virus (HIV) infection have been investigated after treatment with highly active antiretroviral therapy (HAART) including protease inhibitors (PI) but no data are available on the effect of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy on incidence of acquired immunodeficiency syndrome (AIDS) oral manifestations or impact of HAART on oral manifestations of HIV infection in Brazil. The aim of this study was to describe the effects of anti-HIV therapy on the incidence of oral lesions during 17 years of AIDS epidemics in a Brazilian population.


METHODS
From 1989 to 2006, we collected data from 1595 consecutive HIV patients at the Special Care Dentistry Center, São Paulo, Brazil. We compared the effect of PI- and NNRTI-based antiretroviral therapy (ARVT) on the annual incidence of Kaposi sarcoma (KS), oral candidiasis (OC) and hairy leukoplakia (HL). The chi-squared test was used to test the association between oral lesions and therapeutic regimen (P < 0.05).


RESULTS
None of patients on ARVT presented with KS. Patients who used (nucleoside reverse transcriptase inhibitors) NRTI + PI were 0.9 times as likely to present with HL as those who used NRTI + NNRTI. This finding, however, was not statistically significant (P = 0.5). The relative risk for OC was 0.8 in patients with PI-based HAART. The increased risk among those on PIs was statistically significant (P = 0.004).


CONCLUSIONS
The superiority of NNRTI regimens in decreasing OC incidence is consistent with current therapeutic guidelines which recommend NNRTI-based therapy as the treatment of choice for initial ARVT.
Ortega
Karem L
KL
Department of Oral Pathology, Special Care Dentistry Center, University of São Paulo, São Paulo, Brazil. klortega@usp.br
Vale
Daniela A
DA
Magalhães
Marina H C G
MH
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000453:epidemiology; D002613:Cheilitis / Q000453:epidemiology; D015331:Cohort Studies; D003218:Condylomata Acuminata / Q000453:epidemiology; D004890:Erythema / Q000453:epidemiology; D005500:Follow-Up Studies; D005882:Gingival Diseases / Q000453:epidemiology; D005892:Gingivitis, Necrotizing Ulcerative / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D017733:Leukoplakia, Hairy / Q000453:epidemiology; D016483:Lymphoma, AIDS-Related / Q000453:epidemiology; D009059:Mouth Diseases / Q000453:epidemiology*; D009062:Mouth Neoplasms / Q000453:epidemiology; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012514:Sarcoma, Kaposi / Q000453:epidemiology; D013281:Stomatitis, Aphthous / Q000453:epidemiology; D013283:Stomatitis, Herpetic / Q000453:epidemiology
D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors