Oral Lesions and HAART in HIV/AIDS Patients, Kenya

1Thika District Hospital. 2Kenya Medical Research Institute, Centre for Public Health Research. 3Kenya Medical Research Institute, Centre for Public Health Research. 4Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology

Objectives: To determine the spectrum of oral lesions, including oropharyngeal candidiasis(OPC), associated with HIV/AIDS among adults on highly active antiretroviral therapy(HAART).

Methods: A cross-sectional study conducted at the Comprehensive Care Centre(CCC), Thika District Hospital, Kenya. A total of 404 subjects selected from every 5th HIV-infected CCC outpatient on HAART, underwent oral cavity examination for the presence of different clinical forms of OPC and other oral lesions associated with HIV infection. Dates for confirmation of HIV-status and HAART initiation, presence of other illnesses, concurrent medications and most recent CD4+ cell-counts were obtained from individual patient medical records. Gram Stain smears from OPC lesions were examined under a light microscope for the presence of Candida hyphae. Data was recorded in structured questionnaires and standard forms, entered in database application and statistically analyzed using Statistical Package for Social Sciences (SPSS). Data was stratified for periods before and after 24 weeks of HAART initiation for different clinical forms of OPC.

Results: A total of 404(63% female) patients were examined. Oral lesions (oral candidiasis, oral hairy leukoplakia, Kaposi’s and linear gingival erythema) were observed in 63(16%) patients. Oral candidiasis was the commonest (12%), followed by OHL (3%). Erythematous candidiasis was the most predominant type of oral candidiasis (6%) followed by pseudomembranous (5%) and angular cheilitis (1%). A higher occurrence of oral lesions (24.6%) was observed for periods before 24 weeks compared to 15.2% for periods after 24 weeks.

Conclusion: The occurrence of oral lesions associated with HIV/AIDS infection in adult patients on HAART appears lower than what has been observed in various studies on HAART naïve patients. More studies, preferably longitudinal, need to be conducted for long periods of time in order to get a better picture on the effects of HAART on the occurrence of oral lesions in adults in our setting.