American Journal of Epidemiology Vol. 145, No. 2: 164-174
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Development of Oral Lesions in Human Immunodeficiency Virus-infected Transfusion Recipients and Hemophiliacs
1Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, CA
2Department of Laboratory Medicine, School of Medicine, University of California San Francisco, CA
3AIDS Office, San Francisco Department of Public Health San Francisco, CA
4Department of Stomatology, School of Dentistry, University of California San Francisco, CA
5Schools of Public Health and Optometry, University of California Berkeley, CA
Reprint requests to Dr. Joan F. Hilton, Department of Epidemiology and Biostatistics, University of California School of Medicine, San Francisco, CA 94143-0560.
The authors used multivariate repeated-measures transition models to identify risk factors for two oral lesions related to human immunodeficiency virus (HIV)—candidiasis and hairy leukoplakia—in 152 HIV-infected blood transfusion recipients and hemophiliacs. Subjects were examined for occurrences of these lesions every 6 months from July 1985 through March 1993, yielding 1,076 study visits. It was found that, after adjustment for the CD4: CD8 T-lymphocyte ratio, patients with a history of candidiasis in the previous 18 months were at high risk of lesion recurrence. This risk increased with the number of prior episodes and with the recency of the episode(s). A history of hairy leukoplakia was less predictive of persistence of that lesion after adjustment for significant risk factors (including candidiasis and use of antifungal agents at the current examination, a low CD4: CD8 cell ratio, and age less than 40 years). The authors also found a high coprevalence of candidiasis and hairy leukoplakia in these subjects. These results suggest that HIV-infected patients with oral candidiasis should be carefully monitored for subsequent episodes over the next 12–18 months, and patients with either oral candidiasis or hairy leukoplakia and a low CD4: CD8 cell ratio should be carefully examined for the other type of lesion as well. Am J Epidemiol 1997; 145: 164–74.
blood transfusion; candidiasis, oral; hemophilia; HIV seroprevalence; leukoplakia, oral; longitudinal studies; oral manifestations; risk factors
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