Oral HIV and Tuberculosis in a Rural South African Population

Objective: To determine the association between TB and oral lesions among HIV positive individuals. Pulmonary tuberculosis (TB) is presently the leading cause of death among people living with HIV/AIDS in Africa, but only limited information is available on the association between TB and oral manifestation of HIV.

Methods:, A cross-sectional study involving 212 consenting HIV-infected adults (18+yrs) attending an outpatient HIV clinic in a rural area of South Africa. A trained and experienced dentist recorded HIV-associated oral lesions using the criteria suggested by the European commission clearing house on oral HIV. Socio-demographic characteristics of the patients were obtained through a self-administered structured questionnaire. Also recorded were CD4 count, body weight, smoking status, history of TB diagnosis and HART treatment. Data analysis included the use of chi-square and multiple logistic regression.

Results:, The mean (±SD) age of the participants was 33.9 (±8.6) years, with a range of 18-56 years. Most were in stage III or IV (90.1%). Median CD4 count was 146 cells/mm3 and 54.2% were on HART treatment. Of the participants, 70.8% were females, 46.7% presented with an oro-facial manifestation (OM) and 24.1% presented with TB. Those on HART had a lower prevalence of TB (17.4% vs. 32.0%; p=0.013). After controlling for HAART treatment, presenting with TB was significantly associated with having less than 12-years schooling (OR=2.33; 95%CI=1.09-4.96), being a male (2.53; 1.21-5.28) and presenting with aphthous ulcer (5.62; 1.20-26.34).

Conclusions: This study shows a significant relationship between oral HIV lesions,especially oral aphthous ulcer and TB.