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

OBJECTIVES

We evaluated time from HIV seroconversion to diagnosis of two common oral lesions associated with HIV infection and disease progression.

DESIGN

Oral examinations were performed on homosexual and bisexual men enrolled in prospective cohorts.

SETTING

Homosexual and bisexual men were followed in three epidemiologic cohort studies in San Francisco, California, USA.

PARTICIPANTS

Data were evaluated from 80 men with well-defined dates of HIV seroconversion from 1984 through 1991.

MAIN OUTCOME MEASURES: We determined the cumulative incidence of oral candidiasis and hairy leukoplakia after HIV seroconversion.

RESULTS

Four 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 x 10(6)/l when oral candidiasis was first reported and 468 x 10(6)/l when hairy leukoplakia was first reported.

CONCLUSIONS

Oral 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.