Predictive value of group I oral lesions in detecting HIV infection amongst patients attending PHC facilities in Gauteng

Abstract The utilization of oral lesions as a screening tool for HIV is not well documented. Attendees at two primary health care facilities (Khutsong and Heidelberg) were assessed to determine the predictive value of group I oral lesions for HIV infection. The objectives were to investigate the: 1) HIV prevalence amongst attendees at PHC facilities, 2) Prevalence of HIV-related oral lesions and 3) Correlation between the oral lesions and the HIV status using the Likelihood Ratio test. Methods: All patients over 12 months of age presenting at the two facilities for a curative care consultation over a one-week period (in April 2005) were included. Consent was obtained by trained counselors who also conducted a brief interview and offered pre-test counseling to patients wishing to know their HIV status. Two calibrated dentists conducted a head, neck and oral examination and administered a rapid saliva HIV test (OraQuick HIV-1/2-Rapid HIV-1/2 Antibody Test). Results: A total of 654 attendees were surveyed in the 2 facilities. There was a 100% response. The mean age of the participants was 34 years (range: 1-94), and the majority (73%) were female. HIV prevalence rates were 34% at Khutsong and 36% at Heidelberg. The HIV prevalence peaked at 46% in the 16-45 age groups. Of the 228 who tested positive for HIV, 121 (53%) patients were diagnosed with 1 or more Group I oral lesion. Oral candidiasis (46%) and oral hairy leukoplakia (19%) were the two most common oral lesions diagnosed in the HIV positive cohort. The positive predictive values and specificity values for multiple lesions ranged between 96% and 100%. Most of the likelihood ratios for multiple lesions were greater than 10 which implied that the patients who presented with these lesions were extremely likely to test positive for HIV. The sensitivity values (1% to 37%) and negative predictive values (66% to 70%) remained relatively low. Conclusion: The HIV prevalence of patients attending PHC facilities was high (34%). Oral lesions are useful markers of HIV-infection and should alert clinicians to the presence of HIV infection. Multiple group I lesions were more predictive of HIV infection compared to single lesions