Katz M H, Greenspan D, Westenhouse J, Hessol N A, Buchbinder S P, Lifson A R, Shiboski S, Osmond D, Moss A, Samuel M
Oral AIDS Center, Department of Stomatology, School of Dentistry, San Francisco, CA 94143-0512.
AIDS. 1992 Jan;6(1):95-100. doi: 10.1097/00002030-199201000-00013.
This study was designed to assess the significance of HIV-related oral lesions in predicting the rate of progression to AIDS.
Cohorts were investigated prospectively, and oral examinations were performed by clinicians trained in the diagnosis of oral lesions.
We studied three existing cohorts of homosexual and bisexual men in San Francisco, California, USA.
Of the HIV-infected men who received standardized oral examinations (n = 791), 603 were eligible for analysis of baseline examinations and 448 for analysis of follow-up examinations.
We determined time from presence of oral lesion at baseline or follow-up examination, or from participant self-reported history of the lesion, to diagnosis of AIDS.
Using proportional hazard regression and stratifying by CD4 lymphocyte count at the time of baseline oral examination, we found that the rate of development of AIDS was increased among men with hairy leukoplakia [relative hazard, 1.8; 95% confidence interval (CI), 1.2-2.7], oral candidiasis (relative hazard, 7.3; 95% CI, 3.1-17.3), and both lesions (relative hazard, 3.1; 95% CI, 1.6-6.1) compared with men with normal findings. On follow-up examination, stratifying for CD4 count, the rate of progression to AIDS was similar for those with hairy leukoplakia compared with those with oral candidiasis. The progression rate from oral candidiasis to AIDS was faster from presence on baseline examination than from presence on follow-up examination or from self-reported history of the lesion.
The presence of oral candidiasis and/or hairy leukoplakia on baseline examination confers independent prognostic information and should be incorporated into HIV-staging schemes.
本研究旨在评估与HIV相关的口腔病变在预测艾滋病进展率方面的意义。
对队列进行前瞻性调查，由经过口腔病变诊断培训的临床医生进行口腔检查。
我们在美国加利福尼亚州旧金山研究了三个现有的同性恋和双性恋男性队列。
在接受标准化口腔检查的HIV感染男性中（n = 791），603人符合基线检查分析条件，448人符合随访检查分析条件。
我们确定了从基线或随访检查时出现口腔病变，或从参与者自我报告的病变病史到诊断为艾滋病的时间。
使用比例风险回归并按基线口腔检查时的CD4淋巴细胞计数分层，我们发现与检查结果正常的男性相比，有毛状白斑的男性（相对风险，1.8；95%置信区间[CI]，1.2 - 2.7）、口腔念珠菌病的男性（相对风险，7.3；95%CI，3.1 - 17.3）以及两种病变都有的男性（相对风险，3.1；95%CI，1.6 - 6.1）艾滋病发展率增加。在随访检查中，按CD4计数分层，有毛状白斑的人与有口腔念珠菌病的人进展为艾滋病的速率相似。从基线检查时出现口腔念珠菌病到艾滋病的进展速率比从随访检查时出现或从自我报告的病变病史时出现要快。
基线检查时存在口腔念珠菌病和/或毛状白斑可提供独立的预后信息，应纳入HIV分期方案。
