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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 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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          Most cited references 48

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

          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.
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            Classification and diagnostic criteria for oral lesions in HIV infection. EC-Clearinghouse on Oral Problems Related to HIV Infection and WHO Collaborating Centre on Oral Manifestations of the Immunodeficiency Virus.

             DM Williams (1993)
            A consensus has been reached on the classification of the oral manifestations of HIV infection and their diagnostic criteria, based on presumptive and definitive criteria. The former relate to the initial clinical appearance of the lesion and the latter are often the result of special investigations. Candidiasis, hairy leukoplakia, specific forms of periodontal disease [linear gingival erythema, necrotising-(ulcerative) gingivitis and necrotising(ulcerative) periodontitis], Kaposi's sarcoma and non-Hodgkin's lymphoma are strongly associated with HIV infection. Lesions less commonly associated with HIV infection and lesions seen in HIV infection, but not indicative of the disease, are also listed.
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              Effect of highly active antiretroviral therapy on frequency of oral warts.

              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.
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                Author and article information

                Journal
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                2006
                18 August 2006
                : 6
                : 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
                1472-6831-6-12
                10.1186/1472-6831-6-12
                1559688
                16916469
                Copyright © 2006 Hamza et al; licensee BioMed Central Ltd.

                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.

                Categories
                Research Article

                Dentistry

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