Oral lesions in HIV-infected patients, before and after antiretroviral treatment

Abstract

Oral lesions cause considerable morbidity in HIV-infected patients. Antiretroviral therapy (ART) reconstitutes the immune system and reduces the incidence of opportunistic infections and malignancies. The aim of the present study was to determine the prevalence and range of oral lesions in patients before and after starting ART in Harare, Zimbabwe. A longitudinal, prospective study of oral lesions presenting in HIV-infected patients at baseline and three and six months after the initiation of ART was conducted. The study was undertaken at three hospitals in Harare. Two hundred and ten patients were enrolled; 96 (46%) and 49 (23%) patients presented for follow-up at three and six months, respectively. Two-thirds of the patients who completed follow-up were female; median age was 36 years. At six months of ART, the overall prevalence of oral lesions declined signifcantly (p< 0.05). Oral candidiasis was the most common finding and showed the most signifcant reduction on ART. In contrast, the incidence of facial warts increased from baseline to three and six months. ART was effective in reducing the overall prevalence of oral lesions in HIV-infected patients, although incidence was variable depending on the type of lesion. Unmasking immune reconstitution infammatory syndrome to human papillomavirus (HPV) is the likely cause for the increase in facial warts.