Accuracy of diagnoses of HIV-related oral lesions by medical clinician's. Findings from the women's interagency HIV study

Objective: To determine if medical clinicians are as accurate as dental cli nicians in recognizing diagnostic characteristics of HIV-related oral lesio ns. Methods: In 355 HIV-infected participants at five Women's Interagency H IV Study sites, we paired oral examinations conducted within 7 days of each other by dental and medical clinicians. We used the former as a gold stand ard against which to evaluate the accuracy of the latter. We assessed the a ccuracy of the medical clinicians' findings based both on their observation s of abnormalities and on their descriptions of these abnormalities. Result s: Dental clinicians diagnosed some oral abnormality in 38% of participants . When "abnormality" was used as the medical clinicians' outcome, sensitivi ties were 75% for pseudomembranous candidiasis and 58% for erythematous can didiasis, but only 40% for hairy leukoplakia. When a precise description of the abnormality was used as their outcome, sensitivities were 19%, 12% and 20%, respectively. Conclusions: Medical clinicians recognize that HIV-rela ted oral abnormalities are present in 40-75% of cases, but less often descr ibe them accurately. Low sensitivity implies that the true associations of specific oral lesions with other HIV phenomena, such as time until AIDS, mu st be stronger than the literature suggests.