Oral medicine
Predictive value of group I oral lesions for HIV infection

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Objectives

Attendees presenting for treatment of acute illness at primary health care facilities in South Africa were assessed to determine the prevalence of human immunodeficiency virus (HIV) infection and the predictability of group I oral lesions (GOLs) for HIV infection.

Methods

This was a cross-sectional analytical study. Patients >18 years of age were recruited and underwent an oral examination and a HIV test.

Results

A total of 522 attendees were examined and the HIV prevalence was 40%. None of them were taking antiretroviral drugs. GOLs were diagnosed in 53% of HIV patients, with pseudomembranous and erythematous candidiasis being the most common (38% and 24%, respectively). The average odds and likelihood ratios for multiple lesions were high (32 and 30, respectively) and showed a strong correlation between GOLs and a positive HIV status.

Conclusion

The prevalence of HIV (40%) and GOLs (53%) was high. GOLs were useful markers of HIV infection, with multiple lesions being highly predictive of HIV infection.

Section snippets

Methods

This was a cross-sectional analytic study. All patients >18 years old who had attended the Khutsong and Heidelberg PHC facilities in Johannesburg, South Africa, were included in the study population. These 2 PHC facilities, located within the Gauteng province of South Africa, were randomly selected for the study. The study period consisted of 1 week at each facility extending from Monday to Saturday during April 2005.

Only outpatients who presented with acute illnesses (i.e., presenting with

Results

A total of 522 patients attended the 2 PHC facilities, and all of them agreed to participate in the study. There were no statistical differences among the attendees at the 2 facilities in terms of age, gender, and HIV status, and, therefore, they were pooled for ease of description and analysis.

There were significantly more women (73%) than men (P < .005; CI 95%), and the combined mean age was 41.95 years (range 18-94 years). A total of 210 patients (40%) tested positive for HIV, with the

Discussion

In this study, the HIV prevalence was 40% which is considerably higher than the latest South African National HIV and Syphilis Antenatal Seroprevalence survey finding of 18%.1 The higher prevalence observed here could be attributed to the fact that: 1) the national figures are an estimate of the general population, whereas the present study was comprised of ill patients attending PHC facilities; 2) the national figures are obtained from attendees of antenatal facilities (pregnant woman only)

Conclusion

The HIV prevalence in these PHC facilities was high (40%) and more than half (53%) of all HIV-positive patients presented with ≥1 GOL. Some combinations of GOLs (AC and OHL, AC and PC, and PC and OHL) can be considered to be significant predictors of a patient's HIV status. Multiple oral lesions were shown to be excellent predictors of HIV in this study. Single oral lesions, such as OHL and AC, demonstrated high LR values and also are useful predictors of HIV. The presumptive clinical diagnosis

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