Correlation of oral disease with the Walter Reed staging scheme for HIV-1-seropositive patients

This study correlates the prevalent oral disease findings in 390 patients seropositive for human immunodeficiency virus type 1 (HIV-1) with their level of staging (Walter Reed) and depletion of peripheral helper T lymphocytes (CD4+). Chronic lymphadenopathy of the head and neck was a common finding (59.2%) that occurred early in staging progression and did not correlate with depression of helper T-cell levels. Of the three prevalent oral disease findings (oral hairy leukoplakia (OHL), candidiasis, necrotizing ulcerative gingivitis [NUG]) only OHL and NUG were significantly correlated with helper T-cell depletion. The occurrence of visually detectable OHL and NUG corresponds to depletion of peripheral helper T-lymphocyte values in a range of 157 to 299 cells/mm3. This range may represent a more accurate value for biologically significant lymphocyte depletion than the Walter Reed value of 400 cells/mm3. The presence of OHL showed a weak statistical correlation with staging progression, indicating deteriorating immunoregulation. No cases of Kaposi's sarcoma or other HIV-1-associated oral diseases were observed in the sample population, regardless of the patient's staging category or peripheral helper T-lymphocyte count.