Original Article

Prevalence, Incidence, and Recurrence of Oral Lesions Among HIV-Infected Patients on HAART in Alabama: A Two-Year Longitudinal Study

Authors: Irene M. Tamı´-Maury, DMD, DrPH, MSc, James H. Willig, MD, Pauline E. Jolly, PhD, MPH, Sten Vermund, MD, PhD, Inmaculada Aban, PhD, Jeffery D. Hill, DMD, Craig M. Wilson, MD, PhD, Mirjam-Collette Kempf, PhD, MPH

Abstract

Objective: Our aim was to quantify prevalence, incidence, and recurrence of oral lesions (OL) among a population in the Southeast.


Methods: A retrospective study based on chart review was conducted among patients (n = 744) who were ≥19 years of age and initiated highly active antiretroviral therapy (HAART) between January 2000 and June 2006 at the University of Alabama at Birmingham (UAB) 1917 Clinic. Patients' laboratory data and oral conditions were recorded for 2 years after enrollment into the study.


Results: During 2 years of follow-up, the period prevalence of individuals experienced at least one OL was 35.6% (266/744). Among all of the 374 episodes of OL, 183 were new cases, while 57 were recurrences. The OL person-visit incidence rate was 0.02 per 100 person-visits. Oropharyngeal candidiasis (OPC) was the most frequent manifestation in terms of period prevalence (74.9%) with a person-visit incident rate of 0.01 per 100 person-visits.


Conclusions: Patients undergoing HAART continue to be affected by HIV-related oral conditions, especially OPC. These results clearly indicate that OL during HIV infection are still highly prevalent in spite of the improvements in medical care and the availability of HAART.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. HRSA/HAB. Increasing access to dental care. In: Health Resources and Services Administration/HAB, ed. HRSA Care Action. Rockville, MD: US Department of Health and Human Services; 2008.
 
2. Eyeson J, Tenant-Flowers M, Cooper D, et al. Oral manifestations of an HIV positive cohort in the era of highly active anti-retroviral therapy (HAART) in South London. J Oral Pathol Med 2002;31:169-174.
 
3. Powderly WG, Landay A, Lederman MM. Recovery of the immune system with antiretroviral therapy: the end of opportunism? J Am Med Assoc 1998;280:72-77.
 
4. Bartlett J, Fath M, Demasi R. An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults. AIDS 2006;20:2051-2064.
 
5. Michelet C, Arvieux C, François C. Opportunistic infections occurring during highly active antiretroviral treatment. AIDS 1998;12:1815-1822.
 
6. Murphy E, Collier A, Kalish L. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med 2001;135:17-26.
 
7. Temesgen Z, Wright A. Antiretrovirals. Mayo Clin Proc 1999;74:1284-1301.
 
8. Ramirez-Amador V, Esquivel-Pedraza L, Sierra-Madero J, et al. The changing clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions in 1,000 consecutive patients: a 12-year study in a referral center in Mexico. Medicine (Baltimore) 2003;82:39-50.
 
9. Schmidt-Westhausen AM, Priepke F, Bergmann FJ, et al. Decline in the rate of oral opportunistic infections following introduction of highly active antiretroviral therapy. J Oral Pathol Med 2000;29:336-341.
 
10. Greenspan D, Greenspan J. Oral Lesions of HIV/AIDS in Industrialized Countries. 2004. Plenary Lecture of the 5th World Workshop on Oral Health and disease in AIDS, July 6-9, 2004, Phuket, Thailand. [cited 2010 04 November]; Available from: http://www.hivdent.org/_oralmanifestations_/5thWorldWorkshopOnOralHealthAndDiseaseInAIDS/5WWOHDA-MAIN.htm.
 
11. Hodgson T, Greenspan D, Greenspan J. Oral lesions of HIV disease and HAART in industrialized countries. Adv Dent Res 2006;19:57-62.
 
12. Greenspan D, Gange SJ, Phelan JA, et al. Incidence of oral lesions in HIV-1-infected women: reduction with HAART. J Dent Res 2004;83:145-150.
 
13. Nicolatou-Galitis O, Velegraki A, Paikos S, et al. Effect of PI-HAART on the prevalence of oral lesions in HIV-1 infected patients. A Greek study. Oral Dis 2004;10:145-150.
 
14. Greenspan D, Canchola AJ, MacPhail LA, et al. Effect of highly active antiretroviral therapy on frequency of oral warts. The Lancet 2001;357:1411-1412.
 
15. Oral Health in America. A Report of the Surgeon General-Executive Summary. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
 
16. Sawires S, Szekeres G, Coates T. Alabama and HIV/AIDS. Los Angeles: University of California; 2007.
 
17. Sirois D. Oral manifestations of HIV infection and AIDS. Mt Sinai J Med 1998;65:322-332.
 
18. Weinert M, Grimes RM, Lynch DP. Oral manifestations of HIV infection. Ann Intern Med 1996;125:485-496.
 
19. Manfredi R. HIV infection and advanced age emerging epidemiological, clinical and management issues. Ageing Res Rev 2004;3:31-54.
 
20. Miziara ID, Weber R. Oral candidosis and oral hairy leukoplakia as predictors of HAART failure in Brazilian HIV-infected patients. Oral Dis 2006;12:402-407.
 
21. Ulett KB, Willig JH, Lin HY, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS 2009;23:41-49.
 
22. EC-Clearinghouse. EC-Clearinghouse on Oral Problems Related to HIV Infection and WHO Collaborating Centre on Oral Manifestation of Human Immunodeficiency Virus. Classification and diagnostic criteria of oral lesions in HIV infection. J Oral Pathol Med 1993;22:289-291.
 
23. Oleckno W. Essential Epidemiology. Chicago, IL: Waveland Press, Inc; 2002.
 
24. Rothman K. Epidemiology: An Introduction. New York: Oxford Univerity Press, Inc; 2002.
 
25. Patton LL, McKaig R, Strauss R, et al. Changing prevalence of oral manifestations of human immuno-deficiency virus in the era of protease therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:299-304.
 
26. Tappuni AR, Fleming GJ. The effect of antiretroviral therapy on the prevalence of oral manifestations in HIV-infected patients: a UK study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:623-628.
 
27. McDowell MA, Briefel RR. The Dietary Data Collection (DDC) system: an automated interview and coding system for NHANES III. In: Proceedings of the Fourteenth National Nutnient Databank Conference. Ithaca, NY: CBORD Group, Inc; 1990.
 
28. Skolasky R, Phair J, Detels R, et al. Thrush and fever as markers of immune competence in the era of highly active antiretroviral therapy. AIDS Res Hum Retroviruses 2001;17:1311-1316.
 
29. Gaitán-Cepeda LA, Martínez-González M, Ceballos-Salobreña A. Oral candidosis as a clinical marker of immune failure in patients with HIV/AIDS on HAART. AIDS Patient Care STDS 2005;19:70-77.
 
30. Aquino-García S, Rivas M, Ceballos-Salobreña A, et al. Oral lesions in HIV/ AIDS patients undergoing HAART including efavirenz. AIDS Res Hum Retroviruses 2008;24:815-819.
 
31. Hamza OJ, Matee MI, Simon EN, et al. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania. BMC Oral Health2006;6:12.
 
32. Ferreira S, Noce C, Júnior A, et al. Prevalence of oral manifestations of HIV infection in Rio de Janeiro, Brazil from 1988 to 2004. AIDS Patient Care STDS 2007;21:724-731.
 
33. Ramirez-Amador V, Ponde de Leon S, Anaya-Saavedra G, et al. Oral lesions as clinical markers of highly active antiretroviral therapy failure: a nested case-control study in Mexico City. Clin Infect Dis2007;45:925-932.
 
34. Reznik DA. Oral manifestations of HIV disease. Top HIV Med 2005;13:143-148.
 
35. Greenwood I, Zakrzewska J, Robinson P. Changes in the prevalence of HIV-associated mucosal disease at a dedicated clinic over 7 years. Oral Dis 2002;8:90-94.
 
36. Peterson P. Strengthening the prevention of HIV/AIDS-related oral disease: a global approach. Community Dent Oral Epidemiol 2004;32:399-401.
 
37. Tamí-Maury I, Willig J, Vermund S, et al. Contemporary profile of oral manifestations of HIV/AIDS and associated risk factors in a Southeastern US clinic. J Public Health Dent 2011. In press.