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 women (577 HIV-positive and 152 HIV-negative) during baseline examination. Significant differences between the groups were found for the following oral lesions: pseudomembranous candidiasis, 6.1% and 2.0%, respectively; erythematous candidiasis, 6.41% and 0.7%, respectively; all oral candidiasis, pseudomembranous and/or erythematous, 13.7% and 3.3%, respectively. Hairy leukoplakia was observed in 6.1% of HIV-positive women. No significant differences were found for recurrent aphthous ulcers, herpes simplex lesions, or papillomas. Kaposi's sarcoma was seen in 0.5% of HIV-positive and 0% of HIV-negative women. Using multiple logistic regression models controlling for use of antiretrovirals and antifungals, in HIV-positive women the presence of oral candidiasis was associated with a CD4 count <200 cells/microl, cigarette smoking, and heroin/methadone use; the presence of hairy leukoplakia was not related to CD4 count but was associated with high viral load. Oral candidiasis and hairy leukoplakia are confirmed as being common features of HIV infection in women and appear to be associated with HIV viral load, immunosuppression, and various other behaviorally determined variables.

Salivary gland disease in human immunodeficiency virus-positive women from the WIHS study. Women's Interagency HIV Study.

OBJECTIVE: To determine the prevalence of enlargement, tenderness, and absence of saliva on palpation as indicators of salivary gland disease in women who are human immunodeficiency virus (HIV)-positive. STUDY DESIGN: The study subjects are participants in the Women's Interagency HIV Study (WIHS), a multicenter study examining HIV-seropositive women and at-risk HIV-seronegative women. A total of 576 HIV-positive women and 152 HIV-negative women were examined at their baseline oral visit for clinical markers of salivary gland disease. Viral load levels, CD4 counts, and CD8 counts were obtained as part of the related core study. RESULTS: HIV-positive women had higher rates of salivary gland enlargement (4.3%), tenderness (6.9%), and absence of saliva on palpation (26.6%) compared with HIV-negative women, who had rates of 1.3%, 4.6%, and 13.2%, respectively. Absence of saliva was significantly different (P =. 001) between the 2 groups. When 2 of the 3 clinical findings were combined, comparisons between the HIV-positive women and HIV-negative women became significant at the P <.05 level for every combination, except for enlargement/tenderness for the submandibular/sublingual gland. For the HIV-positive women, the viral load was significantly related to enlargement (P =.019) and enlargement/absence of saliva on palpation (P =.037) for the parotids and enlargement (P =.046), absence of saliva (P =.043), and enlargement/absence of saliva (P =.022) for the submandibular/sublingual glands. Significant linear trends were found for increasing viral load and enlargement (P =.013) and enlargement/tenderness (P =.024) for the submandibular/sublingual glands. Significance was present for submandibular/sublingual absence of saliva and tenderness/absence of saliva for CD4 and CD8 medians. CONCLUSIONS: Serostatus is related to salivary gland disease as assessed by glandular enlargement, tenderness, and absence of saliva on palpation. Furthermore, our findings indicate that a multidimensional approach to gland assessment may provide a more complete and perhaps more adequate description of glandular involvement with HIV infection.

Oral health and the quality of life.

The study of the impact of oral diseases and conditions on individuals and societies has been slow to develop but has made major progress during the 1980s. Not only did improvements in understanding oral quality of life require developing and using more social and behavioral outcome measures, it required reassessing clinical indices. Reports on oral quality of life to date are often based on investigations that originally had other purposes; consequently there is inconsistent evidence about the associations among oral health, general health, and quality of life. In fact, in much of the cited literature the evidence is equivocal. Yet, in more recent research designed specifically to investigate quality of life (Meei-Shia Chen, PhD, personal communication, 1991), it is evident that orofacial conditions, diseases, and pain can be disruptive and can have considerable impacts at both the individual and societal levels in terms of reduction in normal activities; conversely, medical and social conditions can affect oral health. It is notable that across studies there is an incongruence between health care professional and patient assessments of quality of life--they view the issues differently. Although oral diseases are very prevalent, the early symptoms are often not severe, leading many individuals to disregard them, or if acknowledged, to define them as normal or unimportant. This may reflect a form of fatalism, i.e., their oral health is as good as could be expected. It is necessary to assess oral health and quality of life over time. Individuals indicating satisfaction or dissatisfaction with appearance, function, and self-esteem at one point in time are doing so against a framework of immediate or long-term expectations. In regard to specific procedures, such as surgery or dentures, it is necessary to know what the individual expects if the health care professional is to provide improvements in perceived and actual quality of life. Similarly, it is difficult to provide meaningful interpretation of self-assessed physical and social functioning and appearance against clinical measures, if the level of earlier dysfunction is not known. For example, in the case of full denture wearers, the evidence might be interpreted to suggest that these individuals have excellent oral quality of life. Without taking into account the extent of physical and social dysfunction and poor appearance prior to the dentures, and the consequent improvement against this base, it is impossible to evaluate and consequently improve quality of life. Understanding this process requires longitudinal studies.(ABSTRACT TRUNCATED AT 400 WORDS)