Prognostic significance of oral lesions in children with perinatally acquired human immunodeficiency virus infection
M. H. Katz, M. T. Mastrucci, P. J. Leggott, J. Westenhouse, J. S. Greenspan and G. B. Scott
Oral AIDS Center, Department of Stomatology, University of California, San Francisco.
OBJECTIVE--To assess the prevalence and prognostic significance of oral
lesions in children with human immunodeficiency virus infection.
DESIGN--Clinical cohort study. SETTING--Children's Hospital Center at
Jackson Memorial Hospital, Miami, Fla. PARTICIPANTS--Ninety-nine children
with perinatally acquired human immunodeficiency virus infection examined
longitudinally for oral lesions. INTERVENTIONS--None. MEASUREMENTS/MAIN
RESULTS--Presence of oral lesions was determined by a pediatrician who had
been trained in the diagnosis of oral lesions. The cumulative prevalence of
lesions was 72% for oral candidiasis, 47% for parotid enlargement, and 24%
for herpes simplex. The median time from birth to development of a lesion
was 2.4 years for candidiasis, 4.6 years for parotid enlargement, and 5
years for herpes simplex. The median time from lesion to death was 3.4
years for patients with candidiasis, 5.4 years for patients with parotid
enlargement, and 4.3 years for patients with herpes simplex. In a
time-dependent proportional-hazards model, oral candidiasis was associated
with a more rapid rate of progression to death (relative hazard, 14.2; 95%
confidence interval, 4.8 to 41.8), while parotid enlargement was associated
with a less rapid rate of progression to death (relative hazard, 0.38; 95%
confidence interval, 0.16 to 0.88) and herpes simplex was unrelated to the
rate of progression (relative hazard, 1.3; 95% confidence interval, 0.5 to
3.1). CONCLUSIONS--The presence of oral candidiasis and parotid enlargement
confer important prognostic information and should be incorporated into
decisions regarding therapy for HIV-infected children.
