Changing prevalence of oral manifestations of human immunodeficiency virusin the era of protease inhibitor therapy

Objective. The purpose of this study was to determine temporal trends in th e prevalence of oral manifestations of human immunodeficiency virus (HIV). Study design. Five hundred seventy HIV-infected adults recruited consecutiv ely were examined by using established presumptive clinical criteria for HI V-associated oral lesions. Prevalence of oral lesions before the widespread use of HIV protease inhibitors (February 1995 through August 1996, 8% of t he early sample, n = 271) was compared with lesion prevalence in a more rec ent period of greater protease inhibitor use (December 1996 through Februar y 1999, 42% of the late sample, n = 299). Results. Overall prevalence of oral lesions significantly decreased from ea rly to late periods, 47.6% to 37.5%, respectively (P = .01), with some vari ation by lesion type. Prevalence of hairy leukoplakia (25.8% to 11.4%; P < .01) and necrotizing periodontal diseases (4.8% to 1.7%; P = .03) decreased , whereas HIV salivary gland disease increased (1.8% to 5.0%; P = .04). Cha nges in prevalence of oral candidiasis (20.3% to 16.7%), aphthous ulcers (3 .7% to 3.0%), oral warts (2.2% to 4.0%), herpes simplex virus lesions (1.8% to 2.0%), and Kaposi's sarcoma (1.1% to 0.3% were not statistically signif icant (P > .20 for all comparisons). Conclusion. The pattern of oral opportunistic infections is changing in the era of protease inhibitor use.