THE ACCURATE DIAGNOSIS OF ORAL LESIONS IN HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - IMPACT ON MEDICAL STAGING

Objective: To compare identification of oral candidiasis (OC) and oral hairy leukoplakia (OHL) by medical examiners and oral/dental examiner s and to assess the impact of these diagnoses on the medical staging o f the human immunodeficiency virus (HIV). Design: Retrospective analys is of data collected by medical and oral/dental examiners at the basel ine examination of a prospective study. Setting: Homosexual men and me n and women who were parenteral drug users residing in New York City, enrolled in a longitudinal cohort study. Subjects: A total of 245 indi viduals participated in this study. Main Outcome Measures: The diagnos es of OC and OHL as recorded in the medical and oral/dental charts wer e analyzed retrospectively for the same medical and oral/dental evalua tion visits. The medical staging of HIV infection based on that evalua tion was analyzed concomitantly. Results: Among homosexual men, the or al/dental examiners diagnosed OC in 11% of the individuals and the med ical examiners in 4%. In the same cohort, OHL was diagnosed by the ora l/dental examiners in 14% of the individuals and by the medical examin ers in 8%. Among the parenteral drug users the oral/dental examiners d iagnosed OC in 29% of the individuals while the medical examiners made this diagnosis in 11%. In the same cohort, OHL was diagnosed by the o ral/dental examiners in 9% of the individuals and by the medical exami ners in 2%. The OC and OHL diagnoses affected the medical staging of 1 2% of the HIV-positive homosexual men and of 22% of the HIV-positive p arenteral drug users. Forty percent of the HIV-positive homosexual men and 79% of the HIV-positive parenteral drug users with stage-defining oral lesions were not properly identified by the medical examiners. C onclusions: Specific training and a comprehensive oral examination hav e a significant impact on the diagnoses of OC and OHL, and on the medi cal staging of individuals with HIV infection.