ORAL LESIONS AS MARKERS OF SEVERE IMMUNOSUPPRESSION IN HIV-INFECTED HOMOSEXUAL MEN AND INJECTION-DRUG USERS

Objectives. We examined the diagnostic utility of the presence of oral lesions, individually and in combination, in identifying severe immun osuppression, defined as CD4 cell count under 200. Study design. Data were collected on 82 HIV-seropositive homosexual men and 82 HIV-seropo sitive injection drug users who volunteered to participate in a longit udinal study of HIV infection. CD4 cell counts were measured within 24 hours of oral examination. Methods. Sensitivity, specificity, positiv e predictive value, negative predictive value, and the odds ratio were computed to assess the association between oral lesions and CD4 less than 200, In addition to the individual lesions, we studied the diagno stic properties of sets of three to six lesions. For each set of lesio ns, a patient was classified as positive for the set if he or she had one or more lesions in that set. Results. In homosexual men and inject ion drug users, individual lesions had low sensitivity, high specifici ty, and moderate positive and negative predictive values. Odds ratios reflected weak correlation to immunosuppression. When lesion sets were considered in homosexual men, sensitivity rose dramatically with only modest decreases in specificity. The positive and negative predictive values remained almost the same. Similar results for lesion sets were obtained in injection drug users, with greater reduction in specifici ty but stable positive and negative predictive values. Odds ratios ind icated that for homosexual men, the more lesions included in the set, the stronger the correlation with immunosuppression. For injection dru g users, strong correlations were observed for all lesion sets. Conclu sions. Analysis of sensitivities and odds ratios in homosexual men sug gest that it may be valid to note the occurrence of a greater number o i oral lesions than is currently done in staging patients with HIV inf ection. Among injection drug users, monitoring a larger number of lesi ons neither improves nor reduces the correlation to severe immunosuppr ession.