Sensitivity, specificity, and positive predictive value of oral opportunistic infections in adults with HIV/AIDS as markers of immune suppression andviral burden

Objectives. The purpose of this study was to assess the use of human immuno deficiency virus (HIV)-related owl opportunistic infections as markers of i mmune suppression and viral burden in adults with HIV/acquired immunodefici ency syndrome (AIDS). Methods. The population consisted of a single institution observational coh ort involving 606 patients With HIV/AIDS with CD4 count data and 277 with p lasma viral load measurements examined between 1995 and 1999 for the presen ce of oral manifestations of HIV. Sensitivity, specificity, positive predic tive value (PPV), and negative predictive value is reported for the associa tion of specific oral lesions and lesion sets with CD4 counts <200 cells/mm (3) and with plasma HIV RNA greater than or equal to 20,000 copies/mL. Results. Lesions with moderate-to-high PPVs for CD4 <200 cells/mm(3) were a s follows: Kaposi's sarcoma (100%; P = .035), pseudomembranous candidiasis (82.2%; P < .001), linear gingival erythema (70.0%; P = .015), hairy leukop lakia (66.3%; P < .001), angular cheilitis (60.0%; P = .128), and erythemat ous candidiasis (58.3%; P = .061). Necrotizing ulcerative periodontal disea ses, HIV salivary gland disease, oral ulcers, and oral warts had PPVs below 50%. Concurrent infection with candidiasis and hairy leukoplakia had the h ighest PPV of 89.3%; P < .001. PPVs for HIV RNA greater than or equal to 20 ,000 copies/mL ranged from 27.3% to 100%, with significant association only for pseudomembranous candidiasis. Conclusions, Specific common oral lesions are strongly associated with immu ne suppression, as measured by CD4 cell counts, and are modestly associated with high viral burden, thus serving as potential clinical markers of HIV viremia and the consequent destruction of the immune system with progressiv e HIV disease.