Time from HIV seroconversion to oral candidiasis or hairy leukoplakia among homosexual and bisexual men enrolled in three prospective cohorts

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ObjectivesWe evaluated time from HIV seroconversion to diagnosis of two common oral lesions associated with HIV infection and disease progression.DesignOral examinations were performed on homosexual and bisexual men enrolled in prospective cohorts.SettingHomosexual and bisexual men were followed in three epidemiologic cohort studies in San Francisco, California, USA.ParticipantsData were evaluated from 80 men with well-defined dates of HIV seroconversion from 1984 through 1991.Main outcome measuresWe determined the cumulative incidence of oral candidiasis and hairy leukoplakia after HIV seroconversion.ResultsFour per cent of men developed oral candidiasis within 1 year after HIV seroconversion, 8% within 2, 15% within 3, 18% within 4, and 26% within 5 years. Nine per cent developed hairy leukoplakia within 1 year, 16% within 2, 25% within 3, 35% within 4, and 42% within 5 years. The median CD4+ count was 391 x106/l when oral candidiasis was first reported and 468x106/l when hairy leukoplakia was first reported.ConclusionsOral candidiasis or hairy leukoplakia appeared in a significant proportion of HIV-infected homosexual and bisexual men. These lesions occurred relatively soon after HIV seroconversion, typically before AIDS. Evaluation of HIV-infected individuals for these lesions has many potential clinical and research benefits, including the possible use of oral lesions as primary end-points in clinical trials.

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