Pattern of adult HIV infection-associated orofacial lesions and their relatonship with ARV therapy, immune status and tuberculosis in a Nairobi centre.

Abstract

Background: Oral lesions, among them Kaposi's sarcoma, oral candidiasis and hairy leucoplakia have been a feature of the HIV infection from the time of the first reports and have been included in the classification of the disease. The lesions have been found to be significantly more common at CD4 cell counts below 200 and significantly less common among the subjects who are on ARV therapy. Co-prevalence between pseudomembranous candidiasis and tuberculosis [TB] has been described with suggestions that the lesion could be used as a clinical predictor of TB. Objectives: To describe the pattern and distribution of oro-facial lesions and to determine the relationship between the lesions and the CD4 cell counts, antiretroviral [ARV] therapy and TB among HIV infected subjects. Materials and methods: A descriptive cross-sectional study was carried out among 282 HIV infected adults, comprising 160 females and 122 males aged 18-64 years (mean=38 years), who were conveniently selected at the comprehensive care centre of the Kenyatta National Hospital. A modified University of Western Cape data collection form was used to record the information which included sociodemographic data, presence of systemic disease, CD4 cell counts, duration of ARV therapy and presence of oro-facial lesions. The Chi-square and the student t-tests were used to determine any relationship between categorical and continuous variables respectively. Results: Facial skin eruptions constituted the most common extra-oral lesion(13.1%), followed by thinning of the scalp hair (8.9%), parotomegally (8.1%) and vermilion ulceration(7.6%). Pseudomembranous candidiasis (PMC) was the most common intraoral lesion ([24.5%), followed by hairy leucoplakia(HL) (16%), erythematous candidiasis(EC) (11%), melanotic hyperpigmentationCMHP)(11.4%), atrophic oral mucosa(8.9%),angular cheilitis (7.8%) and Kaposi's sarcoma (1.5%). Thinning of the scalp hair was significantly more common at CD4 cell counts below 200 cells per ml(p=0.030).Although the other lesions were more common at CD4 counts below 200 cells per ml this relationship was not statistically significant. There was a significant relationship between PMC (p<0.001), EC (p<0.001), angular cheilitis(p=O.013) ..• HL((P=0.003), vermilion ulceration(p=0.015) and thinning of scalp hair(p=0.002) and ARV therapy. A positive predictive value of PMC (p=0.006), HL (p=0.032) angular cheilitis (p=0.034), and vermilion ulceration (p=0.020) in predicting TB was seen. Males had a significantly higher prevalence of HL than females (p=0.008). Conclusions: Oral candidiasis was the most common finding with the PMC form being predominant. It was more common at CD4 cell counts below 200 cells per ml and was less common among the subjects on ARV therapy. The lesion was more common among the subjects with TB. Recommendations: PMC could be used as a clinical predictor for the response to ARV therapy and may serve, alongside other clinical parameters, to predict TB infection; and, therefore, clinicians diagnosing the lesion in a patient with HIV infection should do further investigations for TB.