HUMAN IMMUNODEFICIENCY VIRUS-RELATED ORAL MANIFESTATIONS AND GENDER -A LONGITUDINAL ANALYSIS

Background: Because human immunodeficiency virus (HIV) infection affec ts an increasing number of women in the United States, we investigated the role played by gender in the occurrence of HIV-related oral condi tions. Methods: As part of a 4-year prospective study of 3 epidemiolog ical cohorts, oral and physical examinations (including blood tests) w ere performed on HIV-infected men (n=200) and women (n=218) at 6-month intervals. Our outcome variables included oral conditions commonly as sociated with HIV infection: hairy leukoplakia, candidiasis, ulcers, w arts, non-Hodgkin lymphoma, Kaposi sarcoma, and parotid enlargement. R esults: Only hairy leukoplakia, candidiasis, and ulcers were observed. The occurrence of hairy leukoplakia and candidiasis was higher in men (22% and 24%, respectively) than in women (9% and 13%, respectively) during the study period. A regression model for longitudinal data (gen eralized estimating equation) disclosed that the odds of having hairy leukoplakia were 2.5 times higher for men than for women, after contro lling for CD4(+) cell count, race, and injecting drug use (95% confide nce interval, 1.34-4.76; P=.003). Length of follow-up did not confound this association. A weaker association was found between the occurren ce of oral candidiasis and gender (adjusted odds ratio, 1.85; 95% conf idence interval, 1.0-3.43; P=.05). Conclusions: In this sample of HIV- infected adults, we found that men were significantly more likely to h ave hairy leukoplakia than were women. The hairy leukoplakia-gender as sociation merits further investigation, because it may be related to a gender difference in the mode of expression of Epstein-Barr virus.