Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users

Melissa D. Begg, Katherine S. Panageas, Dennis Mitchell-Lewis, Ronni S. Bucklan, Joan A. Phelan, Ira B. Lamster

Research output: Contribution to journalArticle

Abstract

Objectives. We examined the diagnostic utility of the presence of oral lesions, individually and in combination, in identifying severe immunosuppression, defined as CD4 cell count under 200. Study design. Data were collected on 82 HIV-seropositive homosexual men and 82 HIV-seropositive injection drug users who volunteered to participate in a longitudinal study of HIV infection. CD4 cell counts were measured within 24 hours of oral examination. Methods. Sensitivity, specificity, positive predictive value, negative predictive value, and the odds ratio were computed to assess the association between oral lesions and CD4 less than 200. In addition to the individual lesions, we studied the diagnostic properties of sets of three to six lesions. For each set of lesions, a patient was classified as positive for the set if he or she had one or more lesions in that set. Results. In homosexual men and injection drug users, individual lesions had low sensitivity, high specificity, and moderate positive and negative predictive values. Odds ratios reflected weak correlation to immunosuppression. When lesion sets were considered in homosexual men, sensitivity rose dramatically with only modest decreases in specificity. The positive and negative predictive values remained almost the same. Similar results for lesion sets were obtained in injection drug users, with greater reduction in specificity but stable positive and negative predictive values. Odds ratios indicated that for homosexual men, the more lesions included in the set, the stronger the correlation with immunosuppression. For injection drug users, strong correlations were observed for all lesion sets. Conclusions. Analysis of sensitivities and odds ratios in homosexual men suggest that it may be valid to note the occurrence of a greater number of oral lesions than is currently done in staging patients with HIV infection. Among injection drug users, monitoring a larger number of lesions neither improves nor reduces the correlation to severe immunosuppression.

Original languageEnglish (US)
Pages (from-to)276-283
Number of pages8
JournalOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
Volume82
Issue number3
StatePublished - 1996

Fingerprint

Drug Users
Immunosuppression
HIV
Injections
Odds Ratio
CD4 Lymphocyte Count
HIV Infections
Sensitivity and Specificity
Oral Diagnosis
Drug Monitoring
Longitudinal Studies
Sexual Minorities

ASJC Scopus subject areas

  • Dentistry(all)
  • Pathology and Forensic Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

Cite this

Begg, M. D., Panageas, K. S., Mitchell-Lewis, D., Bucklan, R. S., Phelan, J. A., & Lamster, I. B. (1996). Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 82(3), 276-283.

Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users. / Begg, Melissa D.; Panageas, Katherine S.; Mitchell-Lewis, Dennis; Bucklan, Ronni S.; Phelan, Joan A.; Lamster, Ira B.

In: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, Vol. 82, No. 3, 1996, p. 276-283.

Research output: Contribution to journalArticle

Begg, Melissa D. ; Panageas, Katherine S. ; Mitchell-Lewis, Dennis ; Bucklan, Ronni S. ; Phelan, Joan A. ; Lamster, Ira B. / Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users. In: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1996 ; Vol. 82, No. 3. pp. 276-283.
@article{6a0214ea9fde4d6dab0ad059fb43527f,
title = "Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users",
abstract = "Objectives. We examined the diagnostic utility of the presence of oral lesions, individually and in combination, in identifying severe immunosuppression, defined as CD4 cell count under 200. Study design. Data were collected on 82 HIV-seropositive homosexual men and 82 HIV-seropositive injection drug users who volunteered to participate in a longitudinal study of HIV infection. CD4 cell counts were measured within 24 hours of oral examination. Methods. Sensitivity, specificity, positive predictive value, negative predictive value, and the odds ratio were computed to assess the association between oral lesions and CD4 less than 200. In addition to the individual lesions, we studied the diagnostic properties of sets of three to six lesions. For each set of lesions, a patient was classified as positive for the set if he or she had one or more lesions in that set. Results. In homosexual men and injection drug users, individual lesions had low sensitivity, high specificity, and moderate positive and negative predictive values. Odds ratios reflected weak correlation to immunosuppression. When lesion sets were considered in homosexual men, sensitivity rose dramatically with only modest decreases in specificity. The positive and negative predictive values remained almost the same. Similar results for lesion sets were obtained in injection drug users, with greater reduction in specificity but stable positive and negative predictive values. Odds ratios indicated that for homosexual men, the more lesions included in the set, the stronger the correlation with immunosuppression. For injection drug users, strong correlations were observed for all lesion sets. Conclusions. Analysis of sensitivities and odds ratios in homosexual men suggest that it may be valid to note the occurrence of a greater number of oral lesions than is currently done in staging patients with HIV infection. Among injection drug users, monitoring a larger number of lesions neither improves nor reduces the correlation to severe immunosuppression.",
author = "Begg, {Melissa D.} and Panageas, {Katherine S.} and Dennis Mitchell-Lewis and Bucklan, {Ronni S.} and Phelan, {Joan A.} and Lamster, {Ira B.}",
year = "1996",
language = "English (US)",
volume = "82",
pages = "276--283",
journal = "Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology",
issn = "2212-4403",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Oral lesions as markers of severe immunosuppression in HIV-infected homosexual men and injection drug users

AU - Begg, Melissa D.

AU - Panageas, Katherine S.

AU - Mitchell-Lewis, Dennis

AU - Bucklan, Ronni S.

AU - Phelan, Joan A.

AU - Lamster, Ira B.

PY - 1996

Y1 - 1996

N2 - Objectives. We examined the diagnostic utility of the presence of oral lesions, individually and in combination, in identifying severe immunosuppression, defined as CD4 cell count under 200. Study design. Data were collected on 82 HIV-seropositive homosexual men and 82 HIV-seropositive injection drug users who volunteered to participate in a longitudinal study of HIV infection. CD4 cell counts were measured within 24 hours of oral examination. Methods. Sensitivity, specificity, positive predictive value, negative predictive value, and the odds ratio were computed to assess the association between oral lesions and CD4 less than 200. In addition to the individual lesions, we studied the diagnostic properties of sets of three to six lesions. For each set of lesions, a patient was classified as positive for the set if he or she had one or more lesions in that set. Results. In homosexual men and injection drug users, individual lesions had low sensitivity, high specificity, and moderate positive and negative predictive values. Odds ratios reflected weak correlation to immunosuppression. When lesion sets were considered in homosexual men, sensitivity rose dramatically with only modest decreases in specificity. The positive and negative predictive values remained almost the same. Similar results for lesion sets were obtained in injection drug users, with greater reduction in specificity but stable positive and negative predictive values. Odds ratios indicated that for homosexual men, the more lesions included in the set, the stronger the correlation with immunosuppression. For injection drug users, strong correlations were observed for all lesion sets. Conclusions. Analysis of sensitivities and odds ratios in homosexual men suggest that it may be valid to note the occurrence of a greater number of oral lesions than is currently done in staging patients with HIV infection. Among injection drug users, monitoring a larger number of lesions neither improves nor reduces the correlation to severe immunosuppression.

AB - Objectives. We examined the diagnostic utility of the presence of oral lesions, individually and in combination, in identifying severe immunosuppression, defined as CD4 cell count under 200. Study design. Data were collected on 82 HIV-seropositive homosexual men and 82 HIV-seropositive injection drug users who volunteered to participate in a longitudinal study of HIV infection. CD4 cell counts were measured within 24 hours of oral examination. Methods. Sensitivity, specificity, positive predictive value, negative predictive value, and the odds ratio were computed to assess the association between oral lesions and CD4 less than 200. In addition to the individual lesions, we studied the diagnostic properties of sets of three to six lesions. For each set of lesions, a patient was classified as positive for the set if he or she had one or more lesions in that set. Results. In homosexual men and injection drug users, individual lesions had low sensitivity, high specificity, and moderate positive and negative predictive values. Odds ratios reflected weak correlation to immunosuppression. When lesion sets were considered in homosexual men, sensitivity rose dramatically with only modest decreases in specificity. The positive and negative predictive values remained almost the same. Similar results for lesion sets were obtained in injection drug users, with greater reduction in specificity but stable positive and negative predictive values. Odds ratios indicated that for homosexual men, the more lesions included in the set, the stronger the correlation with immunosuppression. For injection drug users, strong correlations were observed for all lesion sets. Conclusions. Analysis of sensitivities and odds ratios in homosexual men suggest that it may be valid to note the occurrence of a greater number of oral lesions than is currently done in staging patients with HIV infection. Among injection drug users, monitoring a larger number of lesions neither improves nor reduces the correlation to severe immunosuppression.

UR - http://www.scopus.com/inward/record.url?scp=0030225715&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030225715&partnerID=8YFLogxK

M3 - Article

VL - 82

SP - 276

EP - 283

JO - Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

JF - Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

SN - 2212-4403

IS - 3

ER -