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      Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania

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          Abstract

          Background

          The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+ cell count.

          Methods

          Participants were 532 HIV infected patients, 51 children and 481 adults, 165 males and 367 females. Children were aged 2–17 years and adults 18 and 67 years. Participants were recruited consecutively at the Muhimbili National Hospital (MNH) HIV clinic from October 2004 to September 2005. Investigations included; interviews, physical examinations, HIV testing and enumeration of CD4+ T cells.

          Results

          A total of 237 HIV-associated oral lesions were observed in 210 (39.5%) patients. Oral candidiasis was the commonest (23.5%), followed by mucosal hyperpigmentation (4.7%). There was a significant difference in the occurrence of oral candidiasis (χ 2 = 4.31; df = 1; p = 0.03) and parotid enlargement (χ 2 = 36.5; df = 1; p = 0.04) between children and adults. Adult patients who were on HAART had a significantly lower risk of; oral lesions (OR = 0.32; 95% CI = 0.22 – 0.47; p = 0.005), oral candidiasis (OR = 0.28; 95% CI = 0.18 – 0.44; p = 0.003) and oral hairy leukoplakia (OR = 0.18; 95% CI = 0.04 – 0.85; p = 0.03). There was no significant reduction in occurrence of oral lesions in children on HAART (OR = 0.35; 95% CI = 0.11–1.14; p = 0.15). There was also a significant association between the presence of oral lesions and CD4+ cell count < 200 cell/mm 3 (χ 2 = 52.4; df = 2; p = 0.006) and with WHO clinical stage (χ 2 = 121; df = 3; p = 0.008). Oral lesions were also associated with tobacco smoking (χ 2 = 8.17; df = 2; p = 0.04).

          Conclusion

          Adult patients receiving HAART had a significantly lower prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia. There was no significant change in occurrence of oral lesions in children receiving HAART. The occurrence of oral lesions, in both HAART and non-HAART patients, correlated with WHO clinical staging and CD4+ less than 200 cells/mm 3.

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          Changing prevalence of oral manifestations of human immuno-deficiency virus in the era of protease inhibitor therapy.

          L Patton, R McKaig, R. Strauss … (2000)
          The purpose of this study was to determine temporal trends in the prevalence of oral manifestations of human immunodeficiency virus (HIV). Five hundred seventy HIV-infected adults recruited consecutively were examined by using established presumptive clinical criteria for HIV-associated oral lesions. Prevalence of oral lesions before the widespread use of HIV protease inhibitors (February 1995 through August 1996, 8% of the early sample, n = 271) was compared with lesion prevalence in a more recent period of greater protease inhibitor use (December 1996 through February 1999, 42% of the late sample, n = 299). Overall prevalence of oral lesions significantly decreased from early to late periods, 47.6% to 37.5%, respectively (P =.01), with some variation by lesion type. Prevalence of hairy leukoplakia (25. 8% to 11.4%; P .20 for all comparisons). The pattern of oral opportunistic infections is changing in the era of protease inhibitor use.
          Article 0 comments Cited 42 times – based on 0 reviews     Review now
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            Effect of highly active antiretroviral therapy on frequency of oral warts.

            M Cheikh, Joel D Greenspan, Desirée A Crèvecoeur-MacPhail … (2001)
            To investigate changes in the pattern of oral disease associated with highly active antiretroviral therapy (HAART), we assessed the frequency of these lesions in our clinic over 9 years. We retrospectively studied 1280 patients seen between July, 1990, and June, 1999, and related oral findings to medication use, immune function, and viral load. We found significant decreases in oral candidosis, hairy leucoplakia, and Kaposi's sarcoma over time, but no change in the occurrence of aphthous ulcers. There was an increase in salivary-gland disease and a striking increase in warts: three-fold for patients on antiretroviral therapy and six-fold for those on HAART (p=0.01). This pattern of oral disease in a referral clinic suggests that an increase in oral warts could be occurring as a complication of HAART.
            Article 0 comments Cited 40 times – based on 0 reviews     Review now
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              Decline in the rate of oral opportunistic infections following introduction of highly active antiretroviral therapy.

              A.-M. Schmidt-Westhausen, F Priepke, F Bergmann … (2000)
              In recent years the management of human immunodeficiency virus (HIV)-positive individuals has been based on highly active antiretroviral therapy (HAART) comprising a combination of nucleoside analogues or the combination of these agents with protease inhibitors. The aim of the present study was to describe the prevalence of oral lesions in a cohort of 103 HIV-seropositive patients on HAART, to compare these data with the prevalence of lesions prior to HAART and to correlate these finding with the immunologic data. A total of 103 HIV-seropositive patients on HAART were selected. Oral lesions associated with HIV infection and immunological parameters were registered. On re-examination 6 months after the first evaluation, 61/103 patients were available. Comparing the prevalence of oral lesions before and after the onset of HAART, the number of oral lesions was significantly lower (P=0.001). The number of CD4+ cells increased and the viral load decreased significantly after initiation of HAART (P=0.001 and P= 0.0001). On re-examination 6 months later, the prevalence of lesions again decreased significantly (P=0.001). The immunological benefits of HAART may prevent HIV-associated oral lesions in patients with advanced HIV disease. Our results showed that oral manifestations decrease on HAART, but in four patients the immunological effects of therapy did not provide sufficient protection against human papillomavirus (HPV)induced lesions.
              Article 0 comments Cited 36 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Oral Health
                Title: BMC Oral Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6831
                Publication date Collection: 2006
                Publication date (Electronic): 18 August 2006
                Volume: 6
                Page: 12
                Affiliations
                [1 ]Department of Oral Surgery and Oral Pathology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
                [2 ]Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
                [3 ]Department of Preventive and Community Dentistry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
                [4 ]Institute of Traditional Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
                [5 ]Department of Internal Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
                [6 ]WHO Collaborating Center, Dentistry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
                [7 ]Department of Medical Microbiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
                [8 ]Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
                Article
                Publisher ID: 1472-6831-6-12
                DOI: 10.1186/1472-6831-6-12
                PMC ID: 1559688
                PubMed ID: 16916469
                SO-VID: 69d676c1-d7ee-4f16-9d5d-dc31e7365b4e
                Copyright © Copyright © 2006 Hamza et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 May 2006
                Date accepted : 18 August 2006
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Dentistry
                Data availability:
                ScienceOpen disciplines: Dentistry

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