European Archives of Paediatric Dentistry

, Volume 11, Issue 5, pp 242–246 | Cite as

Effect of CD4+ lymphocyte count, viral load, and duration of taking antiretroviral treatment on presence of oral lesions in a sample of South African children with HIV+/AIDS

  • M. S. DuggalEmail author
  • H. Abudiak
  • C. Dunn
  • H. J. Tong
  • T. Munyombwe


AIMS: This was to determine the presence and types of oral mucosal lesions in a sample of HIV+/AIDS South African children taking antiretroviral therapy and to investigate the relationship between CD4+ lymphocyte counts, viral load, duration of taking antiretroviral therapy (DART), and age on presence of oral lesions. METHODS: The samples consisted of 56 South African children aged 0–4 years (mean age =7.09 years) with HIV+/AID, infected at birth. Subjects were divided into two groups according to the presence of oral lesions with test group (patients with oral lesions) and control group (patients with no oral lesions). Children were also divided into two groups, those < 6 years and those ≥ 6 years old to study the effect of age on presence of lesions. RESULTS: Oral Candidiasis was the most common lesion reported in 19/56 children, followed by Recurrent Herpetic Infection in 9 children. Other lesions such as Kaposi’s sarcoma, Multifocal Epithelial Hyperplasia, Oral Hairy Leukoplakia, Linear Gingival Erythema, and oral ulceration were also present. A statistical significant difference in CD4+ lymphocyte count (p value 0.005), and viral load (p value 0.002) was found between the oral lesion and no oral lesion groups, those with oral lesions having a significantly higher viral load and lower CD4+ count. No statistically significant difference between the two groups in terms of the DART effect (p value 0.811) was found. Furthermore, there was no effect of age groups on the presence of lesions in children with HIV+/AIDS. CONCLUSION: This study contributes to the relatively scant literature on the prevalence of oral lesions in children with HIV infection in South Africa and also the relationship of these lesions to the viral load and CD4+ lymphocyte counts.


CD4+ lymphocyte counts viral load Anti-retroviral oral lesions HIV+/AIDS 


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  1. Adurogbangba, M I, Aderinokun, GA, Odaibo, GN, et al. Oro-facial lesions and CD4 counts associated with HIV/AIDS in an adult population in Oyo State, Nigeria. Oral Diseases, 2004;10,319–326.PubMedCrossRefGoogle Scholar
  2. Birnbaum, W, Hodgson, TA, Reichart, PA, et al. Prognostic significance of HIV-associated oral lesions and their relation to therapy. Oral Diseases, 2002; 8 Suppl 2, 110–114.PubMedCrossRefGoogle Scholar
  3. Butt, FM, Vaghela, VP, Chindia, ML. Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection associated oral manifestations. East African Med J, 2007;84,383–388.Google Scholar
  4. Coutsoudis, A, Bobat, RA, Coovadia, HM, et al. The effects of vitamin A supplementation on the morbidity of children born to HIV-infected women. Am J Public Health., 1995;85,1076–1081.PubMedCrossRefGoogle Scholar
  5. da Silva, CA, Dourado, I, Dahia, SR, et al. Oral manifestations of HIV infection in patients receiving highly active antiretroviral therapy (HAART) in Bahia, Brazil. J Public Health Dent, 2008; 68,178–181.PubMedCrossRefGoogle Scholar
  6. Dodd, C L, Greenspan, D, Katz, M H, et al. Oral candidiasis in HIV infection: pseudomembranous and erythematous candidiasis show similar rates of progression to AIDS. AIDS, 1991;5,1339–1343.PubMedCrossRefGoogle Scholar
  7. dos Santos Pinheiro, R, França, TT, Ribeiro, CM, et al. Oral manifestations in human immunodeficiency virus infected children in highly active antiretroviral therapy era. J Oral Path Med 2009;38,613–622.CrossRefGoogle Scholar
  8. EC-Clearinghouse on Oral Problems Related to HIV Infection and WHO Collaborating Centre on Oral Manifestations of the Immunodeficiency Virus. Classification and diagnostic criteria for oral lesions in HIV infection. Journal of Oral Pathology & Medicine, 1993;22,289–291.CrossRefGoogle Scholar
  9. Flanagan, M A, Barasch, A., Koenigsberg, SR, et al. Prevalence of oral soft tissue lesions in HIV-infected minority children treated with highly active antiretroviral therapies. Pediatr Dent 2000;22,287–291.PubMedGoogle Scholar
  10. Gaitan-Cepeda, L, Cashat-Cruz, M, Morales-Aguirre, JJ, et al. Prevalence of oral lesions in Mexican children with perinatally acquired HIV: association with immunologic status, viral load, and gender. AIDS Patient Care & Stds, 2002;16,151–156.CrossRefGoogle Scholar
  11. Gortmaker, SL, Hughes, M, Cervia, J, et al. Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. New England J Med, 2001; 345,1522–1528.CrossRefGoogle Scholar
  12. Hamza, O J, Matee, M I, Simon, EN, et al. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania. BMC Oral Health, 2006;6,12.PubMedCrossRefGoogle Scholar
  13. Josephine, M, Issac, E, George, A, et al. Patterns of skin manifestations and their relationships with CD4 counts among HIV/AIDS patients in Cameroon. Int J Dermatol, 2006;45,280–284.PubMedCrossRefGoogle Scholar
  14. Kerdpon, D, Pongsiriwet, S, Pangsomboon, K, et al. Oral manifestations of HIV infection in relation to clinical and CD4 immunological status in northern and southern Thai patients. Oral Dis 2004; 10,138–144.PubMedCrossRefGoogle Scholar
  15. Khongkunthian, P, Grote, M, Isaratanan, W, et al. Oral manifestations in 45 HIV-positive children from Northern Thailand. J Oral Path Med, 2001;30,549–552.CrossRefGoogle Scholar
  16. Magder, LS, Mofenson, L, Paul, ME, et al. Risk Factors for In Utero and Intrapartum Transmission of HIV. J Acquired Immue Defic Synd, 2005;38,87–95.CrossRefGoogle Scholar
  17. Mellors, JW, Munoz, A, Giorgi, JV, et al. Plasma Viral Load and CD4+ Lymphocytes as Prognostic Markers of HIV-1 Infection. Annals Internal Med, 1997;126,946–954.Google Scholar
  18. Mellors, JW, Rinaldo, CR, Gupta, P, et al. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science, 1996;272,1167–1170.PubMedCrossRefGoogle Scholar
  19. Miziara, ID, Filho, BC, Weber, R. Oral lesions in Brazilian HIV-infected children undergoing HAART. Int J Pediatr Otorhinolaryngol, 2006;70,1089–1096.PubMedCrossRefGoogle Scholar
  20. Miziara, ID, Valentini, M, Romano, FR, Miniti, A. Changing patterns of buccal manifestations in AIDS. Revue de Laryngologie Otologie Rhinologie, 2002;123,231–234.PubMedGoogle Scholar
  21. Miziara, ID, Weber, R. Oral candidosis and oral hairy leukoplakia as predictors of HAART failure in Brazilian HIV-infected patients. Oral Dis, 2006;12,402–7.PubMedCrossRefGoogle Scholar
  22. Miziara, ID, Weber, R. Oral lesions as predictors of highly active antiretroviral therapy failure in Brazilian HIV-infected children. J Oral Path Med, 2008;37,99–106.CrossRefGoogle Scholar
  23. Naidoo, S, Chikte, U. Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients. Oral Diss, 2004;10,13–18.CrossRefGoogle Scholar
  24. Nicolatou-Galitis, O, Velegraki, A, Paikos, S, et al. Effect of PI-HAART on the prevalence of oral lesions in HIV-1 infected patients. A Greek study. Oral Dis, 2004;10,145–150.Google Scholar
  25. Okunseri, C, Badner, V, Wiznia, A, et al. Prevalence of oral lesions and percent CD4+ T-lymphocytes in HIV-infected children on antiretroviral therapy. AIDS Patient Care STDS, 2003;17,5–11.PubMedCrossRefGoogle Scholar
  26. Patton, LL, McKaig, RG, Eron, JJ Jr, et al. Oral hairy leukoplakia and oral candidiasis as predictors of HIV viral load. AIDS, 1999;13,2174–2176.PubMedCrossRefGoogle Scholar
  27. Patton, LL. Sensitivity, specificity, and positive predictive value of oral opportunistic infections in adults with HIV/AIDS as markers of immune suppression and viral burden. Oral Surgery Oral Surg, Oral Med, Oral Path, Oral Radiol, Endodontol, 2000;90,182–188.CrossRefGoogle Scholar
  28. Pomarico, L, Cerqueira, DF, de Araujo Soares, RM, et al. Associations among the use of highly active antiretroviral therapy, oral candidiasis, oral Candida species and salivary immunoglobulin A in HIV-infected children. Oral Surg, Oral Med, Oral Path, Oral Radiol, Endodontol, 2009;108,203–210.CrossRefGoogle Scholar
  29. Ramos-Gomez, FJ. Oral aspects of HIV infection in children. Oral Dis, 1997;3 Suppl 1,S31–5.PubMedGoogle Scholar
  30. Ramos-Gomez, FJ. Dental considerations for the paediatric AIDS/HIV patient. Oral Dis, 2002;8 Suppl 2,49–54.PubMedCrossRefGoogle Scholar
  31. Ramos-Gomez, FJ, Flaitz, C, Catapano, P, et al. Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected pediatric patients. Collaborative Workgroup on Oral Manifestations of Pediatric HIV Infection. J Clinical Pediatr Dent, 1999;23,85–96.Google Scholar
  32. Ranganathan, K, Hemalatha, R. Oral lesions in HIV infection in developing countries: an overview. Advances in Dent Res, 2006;19,63–68.CrossRefGoogle Scholar
  33. Rudolph, MJ, Ogunbodede, EO, Mistry, M. Management of the oral manifestations of HIV/AIDS by traditional healers and care givers. Curationis, 2007;30,56–61.PubMedCrossRefGoogle Scholar
  34. Shisana O, Rehle T, Simbayi LC, et al. South African national HIV prevalence, incidence, behaviour and communication survey 2008: A turning tide among teenagers? Cape Town: Survey by HSRC Press 2009.Google Scholar
  35. Umadevi, KM, Ranganathan, K, Pavithra, S, et al. Oral lesions among persons with HIV disease with and without highly active antiretroviral therapy in southern India. J Oral Path Med, 2007;36,136–141.CrossRefGoogle Scholar
  36. UNAIDS. Report on the global HIV/AIDS epidemic, 2008.Google Scholar

Copyright information

© European Archives of Paediatric Dentistry 2010

Authors and Affiliations

  • M. S. Duggal
    • 1
    Email author
  • H. Abudiak
    • 1
  • C. Dunn
    • 1
  • H. J. Tong
    • 1
  • T. Munyombwe
    • 2
  1. 1.Dept. Paediatric Dentistry, Division of Child Dental HealthLeeds Dental InstituteLeedsEngland
  2. 2.Centre for Epidemiology & BiostatisticsUniversity of LeedsLeedsEngland

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