HIV-related oral lesions as markers of immunosuppression in HIV sero-positive Nigerian patients

This study was carried out to assess the use of HIV-related oral lesions as markers of immunosuppression defined as CD4+ cell counts <200 cells/mm and viral load 20,000 copies/ml in HIV positive Nigerian adults. Cross-sectional study on 278 HAART naive adults seen at an AIDS referral Centre.Oral examination was according to the European Community Clearinghouse on oral problems related to HIV infection. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) is reported for oral lesions with plasma HIV-RNA 20,000 copies/ml and CD4 counts <200 cells/mm. The highest PPV (100%) for CD4 <200 cells/mm was noticed from Kaposi’s sarcoma, oral ulcerations and linear gingival erythema, P > 0.05. Lesions with moderate to high PPV for CD4 <200 cells/mm were pseudomembraneous candidiasis (96.3%; P = 0.003), angular cheilitis (96.0%; P = 0.004) erythemathous candidiasis (94.4%; P = 0.025), and melanotic hyperpigmentation (87.1%; P = 0.040). Oral hairy leukoplakia was the only lesion significant for HIVRNA 20,000 copies/ml (PPV: 89.3%; P < 0.05). Oral candidiasis and melanotic hyperpigmentation could be used as markers of immunosuppression depicted by CD4 counts <200 cells/mm while oral hairy leukoplakia could indicate HIVRNA 20,000 copies/ml in an adult Nigerian population.