The impact of Highly Active Antiretroviral Therapy (HAART) on the clinical features of HIV - related oral lesions in Nigeria

Background: This study aimed to determine the therapeutic effects of highly active anti-retroviral therapy (HAART) on the clinical presentations of HIV related oral lesions (HIV-ROLs) in an adult Nigerian population. Methods: A 5 month prospective study on HAART naive HIV positive adults recruited into the HAART program of an AIDS referral centre. HIV-ROLs were diagnosed clinically by the EEC Clearinghouse on oral problems related to HIV infection. Baseline clinical features of HIV-ROLs was documented by clinical photographs using SONY (R) 5.2 M Cybershot digital camera. Post HAART monthly review was conducted using clinical photographs. Results: A total of 142 patients were seen. Age range was 19 - 75 years. Mean age was 35.6 +/- 10.5 (SD). Eighty (56.3%) were females. Prevalence of HIV-ROLs was 43.7%. Oral candidiasis (22.4%) was the most prevalent HIV-ROL. 114 (83.2%) patients had clinical AIDS at presentation (CDC 1993). 89.4% were placed on Tenofovir/Emtricitabine + 'Nevirapine, 9.9% on Tenofovir/Emtricitabine + Efavirenz. There was strong decline in the clinical features of oral candidiasis from a month of commencing HAART. Oral hairy leukoplakia was slow in responding to HAART. Parotid gland enlargement, melanotic hyperpigmentation and Kaposi's sarcoma were more persistent and had slower response to HAART. There was no clinical change noticed in linear gingival erythema. Conclusion: HAART has different clinical effects on HIV related oral lesions depending on the size, duration of treatment and etiology of the lesions. HIV-ROLs of fungal origin have the fastest response to HAART. These lesions alongside immunologic parameters can be used as indicators of success or failure of antiretroviral therapy.