Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria
Affiliation(s)
Department of Preventive Dentistry, College of Medicine, University of Lagos, Lagos, Nigeria. Department of Oral Pathology/Oral Biology, College of Medicine, University of Lagos, Lagos, Nigeria.
Department of Preventive Dentistry, College of Medicine, University of Lagos, Lagos, Nigeria. Department of Oral Pathology/Oral Biology, College of Medicine, University of Lagos, Lagos, Nigeria.
ABSTRACT
Background: Oral lesions have been reported to be early clinical features of HIV infection. The objective of this study was to establish the prevalence of oral lesions and the management outcome using HAART in HIV Seropositive patients attending a tertiary hos- pital in Lagos, Nigeria. Methods: This was a prospective study in 114 newly diagnosed adult HIV infected patients (not on antiretroviral therapy), who attended the PEPFAR clinic at Lagos University Teaching Hospital. They were assessed for oral lesions which were evaluated using EEC/WHO—Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Oral examination was carried out and oral lesions detected were recorded. Presence or absence of oral lesions was evaluated following 3 months use of HAART. Results: 114 patients were enrolled into the study, 49(43.0%) males and 65(57.0%) females, with age range of 18-63 years. 42 (36.8%) presented with oral lesions, 19 (45.2%) of which had multiple lesions. Oral Candidiasis which accounted for 47.7% was the most common oral lesion observed followed by Oral Hairy Leukoplakia (21.6%) and oral hyperpigmentation (10.8%). Pseudomembraneous Candidiasis was the most common variant of oral Candidiasis seen. Prevalence of oral lesions was significantly associated with low CD4 count and high viral load. Eighty four percent (84%) of oral lesions disappeared following 3 months of HAART treatment. Conclusion: Oral lesions are common features of HIV and a marker for progression of the disease to AIDS. There was significant reduction in oral lesions following 3 months treatment with HAART.
Background: Oral lesions have been reported to be early clinical features of HIV infection. The objective of this study was to establish the prevalence of oral lesions and the management outcome using HAART in HIV Seropositive patients attending a tertiary hos- pital in Lagos, Nigeria. Methods: This was a prospective study in 114 newly diagnosed adult HIV infected patients (not on antiretroviral therapy), who attended the PEPFAR clinic at Lagos University Teaching Hospital. They were assessed for oral lesions which were evaluated using EEC/WHO—Classification on the diagnostic criteria for oral lesions in HIV. Data were collected using an interviewer administered questionnaire. Oral examination was carried out and oral lesions detected were recorded. Presence or absence of oral lesions was evaluated following 3 months use of HAART. Results: 114 patients were enrolled into the study, 49(43.0%) males and 65(57.0%) females, with age range of 18-63 years. 42 (36.8%) presented with oral lesions, 19 (45.2%) of which had multiple lesions. Oral Candidiasis which accounted for 47.7% was the most common oral lesion observed followed by Oral Hairy Leukoplakia (21.6%) and oral hyperpigmentation (10.8%). Pseudomembraneous Candidiasis was the most common variant of oral Candidiasis seen. Prevalence of oral lesions was significantly associated with low CD4 count and high viral load. Eighty four percent (84%) of oral lesions disappeared following 3 months of HAART treatment. Conclusion: Oral lesions are common features of HIV and a marker for progression of the disease to AIDS. There was significant reduction in oral lesions following 3 months treatment with HAART.
Cite this paper
Eweka, O. , Agbelusi, G. and Odukoya, O. (2012) Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria. Open Journal of Stomatology, 2, 200-205. doi: 10.4236/ojst.2012.23036.
Eweka, O. , Agbelusi, G. and Odukoya, O. (2012) Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria. Open Journal of Stomatology, 2, 200-205. doi: 10.4236/ojst.2012.23036.
References
[1] Centers for Disease Control and Prevention (1993) Revised classification system for HIV infection and expanded surveil-lance case definition for AIDS among adolescents and adults. MMWR Recommendation and Reports, 41, 1-19. [2] McNeil, D.G. Jr. (2007) U.N. agency to say it overstated extent of HIV cases by millions. New York Times. [3] Greenspan, J.S., Barr, C.E., Sciubba, J.J. and Winkler, J. R. (1992) Oral manifestations of HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, 73, 142-144. doi:10.1016/0030-4220(92)90185-S [4] Kaminu, H.N. and Naidoo, S. (2002) Oral HIV lesions and oral health behaviour of HIV-positive patients attending the Queen Elizabeth II Hospital, Maseru, Lesotho. Journal of the South African Dental Association, 57, 479- 482. [5] Pindborg, J.J. (1989) Classification of oral lesions associated with HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, 67, 292-295. doi:10.1016/0030-4220(89)90358-7 [6] Taiwo, O., Okeke, E.N., Otoh, E.C. and Danfillo, I.S. (2005) Prevalence of HIV-related oral lesions in Nigerian women. Nigerian Journal of Medicine, 14, 132-136. [7] Patton, L.L. (2000) Sensitivity, specificity and positive predictive value of oral opportunistic infections in adults with HIV/AIDS as markers of immune suppression and viral burden. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 90, 294-298. [8] Schmidt-Westhausen, A.M., Priepke, F., Berg-man, F.J. and Riechart, P.A. (2000) Decline in the rate of Oral opportunistic infections following introduction of HAART. Journal of Oral Pathology & Medicine, 29, 336-341. doi:10.1034/j.1600-0714.2000.290708.x [9] Tappuni, A.R. and Fleming, G.J.P. (2001) The effect of antiretroviral therapy on the prevalence of oral manifestations in HIV-infected patients: A UK study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 92, 623-628. doi:10.1067/moe.2001.118902 [10] (1993) EC-Clearinghouse on oral Problems Related to HIV Infection and WHO Collabo-ration Center on oral manifestations of the immunodeficiency Virus. Classification and diagnostic criteria for oral lesions in HIV infection. Journal of Oral Pathology & Medicine, 22, 289- 291. [11] World Health Organization (2005) Interim WHO clinical staging of HIV/ AIDS and HIV/AIDS case definitions for surveillance: African region. 1-42. [12] Iain, L.C. and Hamburger, J. (2000) The significance of oral health in HIV disease. Sexually Transmitted Infections, 76, 236-243. [13] Butt, F.M.A., Vaghela, V.P., Chindia, M.L. and Mandalia, K. (2001) Oral manifestation of HIV/AIDS in Kenyan Provincial Hospital. East African Medical Journal, 78, 389-401. doi:10.4314/eamj.v78i8.8988 [14] Matee, M., Scheutz, F. and Moshy, J. (2000) Occurrence of oral lesions in relation to clinical and immunological status among HIV infected adult Tanzanians. Oral Diseases, 6, 106-111. doi:10.1111/j.1601-0825.2000.tb00110.x [15] Glick, M., Muzyka, B.C., Lurie, D. and Salkin, L.M. (1994) Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS. Oral Surgery, Oral Medicine, Oral Pathology, 77, 344- 349. doi:10.1016/0030-4220(94)90195-3 [16] Arotiba, J.T., Adebola, R.A., Iliyasu, Z., Babashani, M., Shokunbi, W.A., Ladipo, M.M.A. et al. (2005) Oral manifestations of HIV/AIDS infec-tion in Nigerian patients seen in Kano. Nigerian Journal of Surgical Research, 7, 176-181. [17] Taiwo, O.O., Okeke, E.N., Jalo, P.H. and Danfillo, I.S. (2006) Oral manifestation of HIV/AIDS in Plateau state indigenes, Nigeria. West African Journal of Medicine, 25, 32-37. [18] Arotiba, J.T., Arowojolu, M.O., Fasola, A.O., Denloye, O.O. and Obiechina, A.E. (2006) Oral manifestation of HIV/AIDS. African Journal of Medicine and Medical Sciences, 35, 13-18. [19] Adedigba, M.A., Ogunbodede, E.O., Jeboda, S.O. and Naidoo, S. (2008) Patterns of oral manifestation of HIV/ AIDS among 225 Nigerian pa-tients. Oral Diseases, 4, 314-316. [20] Onunu, A.N. and Obueke, N. (2002) HIV-related oral diseases in Benin City, Nigeria. West African Journal of Medicine, 21, 9-11. [21] Wright, A.A. and Agbelusi, G.A. (2005) Group II and III lesions in HIV positive Nigerians attending the general Hospital Lagos, Nigeria. OdontoStomatologie Tropicale, 28, 19-23. [22] Katz, M.H., Mastrucci, M.T., Leggott, P.J., Westenhouse, J., Greenspan, J.S. and Scott, G.B. (1993) Prog-nostic significance of oral lesions in children with perinatally acquired HIV infection. American Journal of Diseases of Children, 147, 45-48. [23] Hamza, O.J., Matee, M.I., Simon, E.N., Kikwilu, E., Moshi, M.J., Mugusi, F. et al. (2006) Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania. BMC Oral Health, 6, 12. doi:10.1186/1472-6831-6-12 [24] Anteyi, K.O., Thacher, T.D., Yohanna, S. and Idoko, J.I. (2003) Oral manifestation of HIV/AIDS in Nigerian patients. International Journal of STD & AIDS, 14, 395-398. doi:10.1258/095646203765371286 [25] Agbelusi, G.A. and Wright, A.A. (2003) Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria. Oral Diseases, 11, 370-373. doi:10.1111/j.1601-0825.2005.01132.x [26] Greenspan, D. and Greenspan, J.S. (1996) HIV-related oral disease. The Lancet, 348, 729-733. doi:10.1016/S0140-6736(96)02308-2 [27] Arendorf, T.M. Bredekamp, B. and Cloete, C.A.C. (1998) Oral manifestations of HIV infection in 600 South African patients. Journal of Oral Pathology & Medicine, 27, 176-179. [28] Campisi, G., Pizzo, G., Mancuso, S. and Margiotta, V. (2001) Gender differences in HIV-related oral lesions: An Italian study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 91, 546-551. [29] Nittayananta, W., Chanowanna, N., Slipapojakul, K., Rodklal, A., Jaruratanasiri-kul, S. and Liewchanpatana, K. (2002) Co-existence between oral lesions and opportunity systemic diseases among HIV-infected subjects in Thailand. Journal of Oral Pathology & Medicine, 31, 163-168. doi:10.1034/j.1600-0714.2002.310307.x [30] Kerdpon, D., Pongsiriwet, S., Pangsomboon, K., Lamrooz, A. and Kampoo, K. (2004) Oral Manifestation of HIV infection in relation to clinical and CD4 immunological status in Northern and Southern Thai patients. Oral Diseases, 10, 138-144. doi:10.1046/j.1601-0825.2003.00990.x [31] Greenspan, D., Greenspan, J.S. Conant, M., Peterson, V., Silverman, S. and De Sonza, Y. (1984) Oral “Hairy” leu- koplakia in male homo-sexuals: Evidence of association with both papilloma virus and a herpes group virus. The Lancet, 324, 831-834. doi:10.1016/S0140-6736(84)90872-9 [32] Shiboski, C.H., Hilton, J.F. Neuhaus, J.M., Canchola, A. and Greenspan, D. (1996) HIV-related oral manifestations and gender. A longitudinal analysis. Archives of Internal Medicine, 156, 2249-2254. doi:10.1001/archinte.1996.00440180113014 [33] Schiodt, M., Bakilana, P.B., Haza, F.R. et al. (1990) Oral candidiasis and hairy leukoplakia correlate with HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, 69, 591-596. doi:10.1016/0030-4220(90)90242-K [34] Ranganathan, K., Reddy, B., Kumarasamy, N., Solomon, S., Viswanathan, R. and Johnson, L. (2000) Oral lesions and conditions associated with HIV infection in 300 South Indian patients. Oral Diseases, 6, 152-157. doi:10.1111/j.1601-0825.2000.tb00326.x [35] Holms, H.K. and Stephen, L.X.G. (2002) Oral lesions of HIV infection in developing countries. Oral Diseases, 8, 40-43. doi:10.1034/j.1601-0825.2002.00010.x [36] Cauda, R., Tac-conelli, E., Tumbarelo, M., Morace, G., De Bernadis, F., et al. (1999) Role of protease inhibitor in preventing recurrent oral candidosis in patients with HIV infection: A prospective case-control study. Journal of Acquired Immune Deficiency Syndromes, 21, 20-25. doi:10.1097/00126334-199905010-00003
[1] Centers for Disease Control and Prevention (1993) Revised classification system for HIV infection and expanded surveil-lance case definition for AIDS among adolescents and adults. MMWR Recommendation and Reports, 41, 1-19. [2] McNeil, D.G. Jr. (2007) U.N. agency to say it overstated extent of HIV cases by millions. New York Times. [3] Greenspan, J.S., Barr, C.E., Sciubba, J.J. and Winkler, J. R. (1992) Oral manifestations of HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, 73, 142-144. doi:10.1016/0030-4220(92)90185-S [4] Kaminu, H.N. and Naidoo, S. (2002) Oral HIV lesions and oral health behaviour of HIV-positive patients attending the Queen Elizabeth II Hospital, Maseru, Lesotho. Journal of the South African Dental Association, 57, 479- 482. [5] Pindborg, J.J. (1989) Classification of oral lesions associated with HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, 67, 292-295. doi:10.1016/0030-4220(89)90358-7 [6] Taiwo, O., Okeke, E.N., Otoh, E.C. and Danfillo, I.S. (2005) Prevalence of HIV-related oral lesions in Nigerian women. Nigerian Journal of Medicine, 14, 132-136. [7] Patton, L.L. (2000) Sensitivity, specificity and positive predictive value of oral opportunistic infections in adults with HIV/AIDS as markers of immune suppression and viral burden. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 90, 294-298. [8] Schmidt-Westhausen, A.M., Priepke, F., Berg-man, F.J. and Riechart, P.A. (2000) Decline in the rate of Oral opportunistic infections following introduction of HAART. Journal of Oral Pathology & Medicine, 29, 336-341. doi:10.1034/j.1600-0714.2000.290708.x [9] Tappuni, A.R. and Fleming, G.J.P. (2001) The effect of antiretroviral therapy on the prevalence of oral manifestations in HIV-infected patients: A UK study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 92, 623-628. doi:10.1067/moe.2001.118902 [10] (1993) EC-Clearinghouse on oral Problems Related to HIV Infection and WHO Collabo-ration Center on oral manifestations of the immunodeficiency Virus. Classification and diagnostic criteria for oral lesions in HIV infection. Journal of Oral Pathology & Medicine, 22, 289- 291. [11] World Health Organization (2005) Interim WHO clinical staging of HIV/ AIDS and HIV/AIDS case definitions for surveillance: African region. 1-42. [12] Iain, L.C. and Hamburger, J. (2000) The significance of oral health in HIV disease. Sexually Transmitted Infections, 76, 236-243. [13] Butt, F.M.A., Vaghela, V.P., Chindia, M.L. and Mandalia, K. (2001) Oral manifestation of HIV/AIDS in Kenyan Provincial Hospital. East African Medical Journal, 78, 389-401. doi:10.4314/eamj.v78i8.8988 [14] Matee, M., Scheutz, F. and Moshy, J. (2000) Occurrence of oral lesions in relation to clinical and immunological status among HIV infected adult Tanzanians. Oral Diseases, 6, 106-111. doi:10.1111/j.1601-0825.2000.tb00110.x [15] Glick, M., Muzyka, B.C., Lurie, D. and Salkin, L.M. (1994) Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS. Oral Surgery, Oral Medicine, Oral Pathology, 77, 344- 349. doi:10.1016/0030-4220(94)90195-3 [16] Arotiba, J.T., Adebola, R.A., Iliyasu, Z., Babashani, M., Shokunbi, W.A., Ladipo, M.M.A. et al. (2005) Oral manifestations of HIV/AIDS infec-tion in Nigerian patients seen in Kano. Nigerian Journal of Surgical Research, 7, 176-181. [17] Taiwo, O.O., Okeke, E.N., Jalo, P.H. and Danfillo, I.S. (2006) Oral manifestation of HIV/AIDS in Plateau state indigenes, Nigeria. West African Journal of Medicine, 25, 32-37. [18] Arotiba, J.T., Arowojolu, M.O., Fasola, A.O., Denloye, O.O. and Obiechina, A.E. (2006) Oral manifestation of HIV/AIDS. African Journal of Medicine and Medical Sciences, 35, 13-18. [19] Adedigba, M.A., Ogunbodede, E.O., Jeboda, S.O. and Naidoo, S. (2008) Patterns of oral manifestation of HIV/ AIDS among 225 Nigerian pa-tients. Oral Diseases, 4, 314-316. [20] Onunu, A.N. and Obueke, N. (2002) HIV-related oral diseases in Benin City, Nigeria. West African Journal of Medicine, 21, 9-11. [21] Wright, A.A. and Agbelusi, G.A. (2005) Group II and III lesions in HIV positive Nigerians attending the general Hospital Lagos, Nigeria. OdontoStomatologie Tropicale, 28, 19-23. [22] Katz, M.H., Mastrucci, M.T., Leggott, P.J., Westenhouse, J., Greenspan, J.S. and Scott, G.B. (1993) Prog-nostic significance of oral lesions in children with perinatally acquired HIV infection. American Journal of Diseases of Children, 147, 45-48. [23] Hamza, O.J., Matee, M.I., Simon, E.N., Kikwilu, E., Moshi, M.J., Mugusi, F. et al. (2006) Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania. BMC Oral Health, 6, 12. doi:10.1186/1472-6831-6-12 [24] Anteyi, K.O., Thacher, T.D., Yohanna, S. and Idoko, J.I. (2003) Oral manifestation of HIV/AIDS in Nigerian patients. International Journal of STD & AIDS, 14, 395-398. doi:10.1258/095646203765371286 [25] Agbelusi, G.A. and Wright, A.A. (2003) Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria. Oral Diseases, 11, 370-373. doi:10.1111/j.1601-0825.2005.01132.x [26] Greenspan, D. and Greenspan, J.S. (1996) HIV-related oral disease. The Lancet, 348, 729-733. doi:10.1016/S0140-6736(96)02308-2 [27] Arendorf, T.M. Bredekamp, B. and Cloete, C.A.C. (1998) Oral manifestations of HIV infection in 600 South African patients. Journal of Oral Pathology & Medicine, 27, 176-179. [28] Campisi, G., Pizzo, G., Mancuso, S. and Margiotta, V. (2001) Gender differences in HIV-related oral lesions: An Italian study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 91, 546-551. [29] Nittayananta, W., Chanowanna, N., Slipapojakul, K., Rodklal, A., Jaruratanasiri-kul, S. and Liewchanpatana, K. (2002) Co-existence between oral lesions and opportunity systemic diseases among HIV-infected subjects in Thailand. Journal of Oral Pathology & Medicine, 31, 163-168. doi:10.1034/j.1600-0714.2002.310307.x [30] Kerdpon, D., Pongsiriwet, S., Pangsomboon, K., Lamrooz, A. and Kampoo, K. (2004) Oral Manifestation of HIV infection in relation to clinical and CD4 immunological status in Northern and Southern Thai patients. Oral Diseases, 10, 138-144. doi:10.1046/j.1601-0825.2003.00990.x [31] Greenspan, D., Greenspan, J.S. Conant, M., Peterson, V., Silverman, S. and De Sonza, Y. (1984) Oral “Hairy” leu- koplakia in male homo-sexuals: Evidence of association with both papilloma virus and a herpes group virus. The Lancet, 324, 831-834. doi:10.1016/S0140-6736(84)90872-9 [32] Shiboski, C.H., Hilton, J.F. Neuhaus, J.M., Canchola, A. and Greenspan, D. (1996) HIV-related oral manifestations and gender. A longitudinal analysis. Archives of Internal Medicine, 156, 2249-2254. doi:10.1001/archinte.1996.00440180113014 [33] Schiodt, M., Bakilana, P.B., Haza, F.R. et al. (1990) Oral candidiasis and hairy leukoplakia correlate with HIV infection. Oral Surgery, Oral Medicine, Oral Pathology, 69, 591-596. doi:10.1016/0030-4220(90)90242-K [34] Ranganathan, K., Reddy, B., Kumarasamy, N., Solomon, S., Viswanathan, R. and Johnson, L. (2000) Oral lesions and conditions associated with HIV infection in 300 South Indian patients. Oral Diseases, 6, 152-157. doi:10.1111/j.1601-0825.2000.tb00326.x [35] Holms, H.K. and Stephen, L.X.G. (2002) Oral lesions of HIV infection in developing countries. Oral Diseases, 8, 40-43. doi:10.1034/j.1601-0825.2002.00010.x [36] Cauda, R., Tac-conelli, E., Tumbarelo, M., Morace, G., De Bernadis, F., et al. (1999) Role of protease inhibitor in preventing recurrent oral candidosis in patients with HIV infection: A prospective case-control study. Journal of Acquired Immune Deficiency Syndromes, 21, 20-25. doi:10.1097/00126334-199905010-00003