title: First report of HIV-related oral manifestations in Mali.
abstract: BACKGROUND
  In 2004, the sudden availability of free antiretroviral therapy (ART in Mali, within the context of an already overburdened health care system created gaps in individual patient quality of care. The objective of this study was to determine the prevalence of HIV-related oral manifestations (OM) during the first month of ART therapy in a Malian health facility.
  
  
  METHODS
  Medical records of adult patients who initiated ART regimens at the Gabriel Touré Hospital, Mali (2001 to 2008) were randomly identified. Multiple logistic regression models were used to evaluate the relationship between the presence of OM during the first month of ART and selected variables, including CD4 counts and WHO clinical staging at ART initiation.
  
  
  RESULTS
  Out of 205 patients on ART (mean age 39 ± 10 years), 71.0% were females and 36.1% had no formal education. 40.6% were in WHO clinical stage III. OM prevalence during the first month of HIV care was 31.4%, being oral candidiasis the commonest lesion. 73.2% and 82.5% of the patients with OM had CD4 count < 200 cells/mm3 and were classified as WHO clinical stage III or IV. WHO clinical stage III and VI patients had 5.4-fold increased odds of having any OM (both p< 0.01) when controlling for age, ethnicity, gender, marital status, and CD4 counts.
  
  
  CONCLUSIONS
  OM detected in people with low CD4 count and WHO clinical stage III and IV at ART initiation suggested that they were very immune-compromised when initiating HIV care. Early identification of OM could improve the quality of care and guarantee the benefits of ART.
authors.affiliation: University of Alabama at Birmingham, Department of Epidemiology, Birmingham, United States.
authors.forename: Irene
authors.initials: I
authors.lastname: Tamí-Maury
authors.forename: Yaya Ibrahim
authors.initials: YI
authors.lastname: Coulibaly
authors.forename: Souare Salimata
authors.initials: SS
authors.lastname: Cissoko
authors.forename: Sounkalo
authors.initials: S
authors.lastname: Dao
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002180:Candidiasis, Oral / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008302:Mali / Q000453:epidemiology; D008875:Middle Aged; D009059:Mouth Diseases / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D011787:Quality of Health Care; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents