Oral Lesions as Clinical Markers of Highly Active Antiretroviral Therapy Failure: A Nested Case‐Control Study in Mexico City
1Universidad Autónoma Metropolitana‐Xochimilco and 2Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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 
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; 
). 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; 
) and oral candidosis (OR, 26.2; 95% CI, 3.34–205.9; 
) 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.
Received 18 March 2007; accepted 4 June 2007; electronically published 23 August 2007.