DEVELOPMENT OF ORAL LESIONS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED TRANSFUSION RECIPIENTS AND HEMOPHILIACS

The authors used multivariate repeated-measures transition models to i dentify risk factors for two oral lesions related to human immunodefic iency virus (HIV)-candidiasis and hairy leukoplakia-in 152 HIV-infecte d blood transfusion recipients and hemophiliacs. Subjects were examine d for occurrences of these lesions every 6 months from July 1985 throu gh March 1993, yielding 1,076 study visits, It was found that, after a djustment for the CD4:CD8 T-lymphocyte ratio, patients with a history of candidiasis in the previous 18 months were at high risk of lesion r ecurrence. This risk increased with the number of prior episodes and w ith the recency of the episode(s). A history of hairy leukoplakia was less predictive of persistence of that lesion after adjustment for sig nificant risk factors (including candidiasis and use of antifungal age nts at the current examination, a low CD4:CD8 cell ratio, and age less than 40 years). The authors also found a high coprevalence of candidi asis and hairy leukoplakia in these subjects. These results suggest th at HIV-infected patients with oral candidiasis should be carefully mon itored for subsequent episodes over the next 12-18 months, and patient s with either oral candidiasis or hairy leukoplakia and a low CD4:CD8 cell ratio should be carefully examined for the other type of lesion a s well.