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Oral lesions as clinical markers of highly active antiretroviral therapy failure: a nested case-control study in Mexico City.
Clin Infect Dis. 2007 Oct 01; 45(7):925-32.CI

Abstract

BACKGROUND

Clinical markers that may predict virological failure during highly active antiretroviral therapy (HAART) have not been evaluated adequately. The aim of the present study was to evaluate the usefulness of human immunodeficiency virus (HIV)-related oral lesions as clinical predictors of virological failure in HIV-infected patients receiving HAART.

METHODS

A nested case-control study was conducted within a cohort of 1134 HIV-infected patients receiving HAART who attended the AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City during the period 1997-2005. Case patients were patients who, after achieving an undetectable viral load, had at least 1 viral load determination > or = 2000 copies/mL while receiving treatment. Control subjects were patients who, after achieving an undetectable viral load, continued to have undetectable viral loads during the follow-up period. There were 2-3 control subjects for each case patient, matched according to duration of follow-up. Oral examinations were blinded to viral loads and CD4+ lymphocyte counts. Analyses were performed with multivariate conditional logistic regression models, and associations were shown as odds ratios (ORs) with 95% confidence intervals (CI). Positive predictive values were calculated.

RESULTS

The target cohort consisted of 431 HIV-infected individuals; 47 case patients and 132 control subjects underwent complete oral examinations and formed the basis of the analysis. At the visit at which an undetectable viral load was determined, case patients and control subjects showed a similar frequency of HIV-related oral lesions (21.3% vs. 17.4%) (OR, 1.39; 95% CI, 0.57-3.38; P=.47). At the visit at which virological failure was determined, case patients showed a higher risk for HIV-related oral lesions (OR, 14.5; 95% CI, 4.21-49.94; P<.001) and oral candidosis (OR, 26.2; 95% CI, 3.34-205.9; P<.001) than did control subjects. The positive predictive value of HIV-related oral lesions and oral candidosis to identify patients who experienced virological failure while receiving HAART was 80% and 83%, respectively.

CONCLUSIONS

HIV-related oral lesions and, specifically, oral candidosis may be considered to be clinical markers of virological failure in HIV-infected patients receiving HAART.

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Authors+Show Affiliations

Ramírez-Amador V
Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico. rava1863@correo.xoc.uam.mx
Ponce-de-León S
No affiliation info available
Anaya-Saavedra G
No affiliation info available
Crabtree Ramírez B
No affiliation info available
Sierra-Madero J
No affiliation info available

MeSH

AIDS-Related Opportunistic InfectionsAdultAntiretroviral Therapy, Highly ActiveBiomarkersCase-Control StudiesDiagnosis, OralDisease ProgressionFemaleHIV InfectionsHumansMaleMexicoMiddle AgedMouth DiseasesOdds RatioTreatment FailureViral Load

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17806063

Citation

Ramírez-Amador, Velia, et al. "Oral Lesions as Clinical Markers of Highly Active Antiretroviral Therapy Failure: a Nested Case-control Study in Mexico City." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 45, no. 7, 2007, pp. 925-32.
Ramírez-Amador V, Ponce-de-León S, Anaya-Saavedra G, et al. Oral lesions as clinical markers of highly active antiretroviral therapy failure: a nested case-control study in Mexico City. Clin Infect Dis. 2007;45(7):925-32.
Ramírez-Amador, V., Ponce-de-León, S., Anaya-Saavedra, G., Crabtree Ramírez, B., & Sierra-Madero, J. (2007). Oral lesions as clinical markers of highly active antiretroviral therapy failure: a nested case-control study in Mexico City. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 45(7), 925-32.
Ramírez-Amador V, et al. Oral Lesions as Clinical Markers of Highly Active Antiretroviral Therapy Failure: a Nested Case-control Study in Mexico City. Clin Infect Dis. 2007 Oct 1;45(7):925-32. PubMed PMID: 17806063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral lesions as clinical markers of highly active antiretroviral therapy failure: a nested case-control study in Mexico City. AU - Ramírez-Amador,Velia, AU - Ponce-de-León,Sergio, AU - Anaya-Saavedra,Gabriela, AU - Crabtree Ramírez,Brenda, AU - Sierra-Madero,Juan, Y1 - 2007/08/23/ PY - 2007/03/18/received PY - 2007/06/04/accepted PY - 2007/9/7/pubmed PY - 2007/10/3/medline PY - 2007/9/7/entrez SP - 925 EP - 32 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 45 IS - 7 N2 - BACKGROUND: Clinical markers that may predict virological failure during highly active antiretroviral therapy (HAART) have not been evaluated adequately. The aim of the present study was to evaluate the usefulness of human immunodeficiency virus (HIV)-related oral lesions as clinical predictors of virological failure in HIV-infected patients receiving HAART. METHODS: A nested case-control study was conducted within a cohort of 1134 HIV-infected patients receiving HAART who attended the AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City during the period 1997-2005. Case patients were patients who, after achieving an undetectable viral load, had at least 1 viral load determination > or = 2000 copies/mL while receiving treatment. Control subjects were patients who, after achieving an undetectable viral load, continued to have undetectable viral loads during the follow-up period. There were 2-3 control subjects for each case patient, matched according to duration of follow-up. Oral examinations were blinded to viral loads and CD4+ lymphocyte counts. Analyses were performed with multivariate conditional logistic regression models, and associations were shown as odds ratios (ORs) with 95% confidence intervals (CI). Positive predictive values were calculated. RESULTS: The target cohort consisted of 431 HIV-infected individuals; 47 case patients and 132 control subjects underwent complete oral examinations and formed the basis of the analysis. At the visit at which an undetectable viral load was determined, case patients and control subjects showed a similar frequency of HIV-related oral lesions (21.3% vs. 17.4%) (OR, 1.39; 95% CI, 0.57-3.38; P=.47). At the visit at which virological failure was determined, case patients showed a higher risk for HIV-related oral lesions (OR, 14.5; 95% CI, 4.21-49.94; P<.001) and oral candidosis (OR, 26.2; 95% CI, 3.34-205.9; P<.001) than did control subjects. The positive predictive value of HIV-related oral lesions and oral candidosis to identify patients who experienced virological failure while receiving HAART was 80% and 83%, respectively. CONCLUSIONS: HIV-related oral lesions and, specifically, oral candidosis may be considered to be clinical markers of virological failure in HIV-infected patients receiving HAART. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/17806063/Oral_lesions_as_clinical_markers_of_highly_active_antiretroviral_therapy_failure:_a_nested_case_control_study_in_Mexico_City_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/521251 DB - PRIME DP - Unbound Medicine ER -