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Oral manifestations of HIV in a southeast USA population
L L Patton1, R G McKaig, R P Strauss
1Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. Lauren_Patton@dentistry.unc.edu
Objectives:
Examine variations in oral manifestations of HIV by gender, race, risk behaviors, substance use and immune status in a previously unstudied population in the southeast region of the USA.
Design:
Cross-sectional analytic study.
Setting:
Academic medical center, North Carolina, USA.
Subjects:
First 238 HIV-infected adults (76% male; 59% Black) enrolled in an ongoing longitudinal study.
Methods:
Oral examination, medical chart review, sociodemographic and behavioral interview. Descriptive, bivariate, and multivariable analyses.
Outcomes:
Presence of oral manifestations of HIV.
Results:
50% had recent CD4 counts < 200 cells microliters-1, 48% had one or more oral lesion. Specific lesion prevalence: hairy leukoplakia (OHL) 26.5%; candidiasis (OC) 20%; HIV-associated periodontal diseases (HIV-PD) 8.8%; aphthae 4.2%; papillomas 2.5%; herpes simplex 2.1%; HIV salivary gland disease 2.1%; Kaposi's sarcoma (KS) 1.7%; other 1.3%. In bivariate analyses, OHL was associated with being male, White, having a CD4 < 200, and men who have sex with men (MSM); OC was associated with CD4 < 200 and current smoking; HIV-PD was associated with consumption of more than seven alcohol-containing drinks per week; KS was associated with being male and MSM. Significant variables in multivariable analysis for presence of any oral lesion were White, CD4 < 200, and more than seven drinks/week; for OHL were male and CD4 < 200; and for OC were White, CD4 < 200, current smoking, and not MSM.
Conclusions:
MSM were at increased risk for KS and OHL, not OC, while smokers were at increased risk of OC. OC, OHL, and any oral lesion were associated with immune suppression. OHL was more likely in males independent of CD4 count.