dc.contributor.author | Koech, Kennedy J | |
dc.date.accessioned | 2013-06-07T08:48:56Z | |
dc.date.available | 2013-06-07T08:48:56Z | |
dc.date.issued | 2005-08 | |
dc.identifier.citation | Koech, K.J(2005). Pattern of adult HIV infection-associated orofacial lesions and their relatonship with ARV therapy, immune status and tuberculosis in a Nairobi centre. | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/29864 | |
dc.description | Master of Dental Surgery thesis | en |
dc.description.abstract | Background: Oral lesions, among them Kaposi's sarcoma, oral candidiasis and hairy
leucoplakia have been a feature of the HIV infection from the time of the first reports and
have been included in the classification of the disease. The lesions have been found to be
significantly more common at CD4 cell counts below 200 and significantly less common
among the subjects who are on ARV therapy. Co-prevalence between
pseudomembranous candidiasis and tuberculosis [TB] has been described with
suggestions that the lesion could be used as a clinical predictor of TB.
Objectives: To describe the pattern and distribution of oro-facial lesions and to determine
the relationship between the lesions and the CD4 cell counts, antiretroviral [ARV]
therapy and TB among HIV infected subjects.
Materials and methods: A descriptive cross-sectional study was carried out among 282
HIV infected adults, comprising 160 females and 122 males aged 18-64 years (mean=38
years), who were conveniently selected at the comprehensive care centre of the Kenyatta
National Hospital. A modified University of Western Cape data collection form was
used to record the information which included sociodemographic data, presence of
systemic disease, CD4 cell counts, duration of ARV therapy and presence of oro-facial
lesions. The Chi-square and the student t-tests were used to determine any relationship
between categorical and continuous variables respectively.
Results: Facial skin eruptions constituted the most common extra-oral lesion(13.1%),
followed by thinning of the scalp hair (8.9%), parotomegally (8.1%) and vermilion
ulceration(7.6%). Pseudomembranous candidiasis (PMC) was the most common intraoral
lesion ([24.5%), followed by hairy leucoplakia(HL) (16%), erythematous
candidiasis(EC) (11%), melanotic hyperpigmentationCMHP)(11.4%), atrophic oral
mucosa(8.9%),angular cheilitis (7.8%) and Kaposi's sarcoma (1.5%). Thinning of the
scalp hair was significantly more common at CD4 cell counts below 200 cells per
ml(p=0.030).Although the other lesions were more common at CD4 counts below 200
cells per ml this relationship was not statistically significant. There was a significant
relationship between PMC (p<0.001), EC (p<0.001), angular cheilitis(p=O.013) ..•
HL((P=0.003), vermilion ulceration(p=0.015) and thinning of scalp hair(p=0.002) and
ARV therapy. A positive predictive value of PMC (p=0.006), HL (p=0.032) angular
cheilitis (p=0.034), and vermilion ulceration (p=0.020) in predicting TB was seen. Males
had a significantly higher prevalence of HL than females (p=0.008).
Conclusions: Oral candidiasis was the most common finding with the PMC form being
predominant. It was more common at CD4 cell counts below 200 cells per ml and was
less common among the subjects on ARV therapy. The lesion was more common among
the subjects with TB.
Recommendations: PMC could be used as a clinical predictor for the response to ARV
therapy and may serve, alongside other clinical parameters, to predict TB infection; and,
therefore, clinicians diagnosing the lesion in a patient with HIV infection should do
further investigations for TB. | en |
dc.language.iso | en | en |
dc.subject | HIV infection | en |
dc.subject | Oro-facial lesions | en |
dc.subject | ARV therapy | en |
dc.subject | Immune status | en |
dc.subject | Tuberculosis | en |
dc.subject | Nairobi | en |
dc.title | Pattern of adult HIV infection-associated orofacial lesions and their relatonship with ARV therapy, immune status and tuberculosis in a Nairobi centre. | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | Department of Oral and Maxillofacial Surgery, Oral Medicine and Oral Pathology | en |