Ability of HIV/AIDS patients to self-diagnose oral opportunistic infections

Objectives: To assess the accuracy of HIV/AIDS patients' self-diagnosis of common HIV-related oral opportunistic infections. Methods: 245 HIV/AIDS pat ients were interviewed regarding the current presence of oral candidiasis ( OC), oral hairy leukoplakia (OHL), and oral ulcers prior to an oral examina tion by an oral medicine trained dentist examiner. Sensitivity, specificity , positive predictive value (PPV) and negative predictive value (NPV) are r eported for the patient's oral lesion diagnosis compared to the dentist's d iagnosis based on established presumptive clinical criteria as the gold sta ndard. Results: Self-diagnosis accuracy was greatest for pseudomembraneous OC (PPV 42.9%; NPV 93.5%), followed by oral ulcers (PPV 35.7%; NPV 98.3%) a nd OHL (PPV 23.5%; NPV 86.4%). Past experience with the lesion improved dia gnostic accuracy, and bothersome symptoms accompanying the lesion had signi ficant impact only for pseudomembraneous OC and oral ulcers. Conclusions: M oderate accuracy of patient self-assessment of oral lesions, with tendency to under rather than over report lesion presence, supports the use of patie nt self-assessment of these lesions to augment clinician diagnosis in clini cal trials. Additionally, HIV/AIDS patients are unlikely to believe they ha ve active OC that would lead to on-demand antifungal use, unless they have had prior experience with the lesion or it is at least moderately bothersom e.