Oral mucosal lesions and HIV viral load in the women's interagency HIV study (WIHS)

The prevalence of oral lesions was assessed in a five-center subset of the Women's Interagency HIV Study (WIHS) and correlated with other features of HIV disease. Oral examinations were performed by dental examiners on 729 wo men (577 HIV-positive and 152 HIV-negative) during baseline examination. Si gnificant differences between the groups were found for the following oral lesions: pseudomembranous candidiasis, 6.1% and 2.0%, respectively; erythem atous candidiasis, 6. 41% and 0.7%, respectively; all oral candidiasis, pse udomembranous and/or erythematous, 13.7% and 3.3%, respectively. Hairy leuk oplakia was observed in 6.1% of HIV-positive women. No significant differen ces were found for recurrent aphthous ulcers, herpes simplex lesions, or pa pillomas. Kaposi's sarcoma was seen in 0.5% of HIV-positive and 0% of HIV-n egative women. Using multiple logistic regression models controlling for us e of antiretrovirals and antifungals, in HIV-positive women the presence of oral candidiasis was associated with a CD4 count <200 cells/<mu>l, cigaret te smoking, and heroin/methadone use; the presence of hairy leukoplakia was not related to CD4 count but was associated with high viral load. Oral can didiasis and hairy leukoplakia are confirmed as being common features of HI V infection in women and appear to be associated with HIV viral load, immun osuppression, and various other behaviorally determined variables.