Relationship between CD4+ count, serum inflammatory cytokines, and oral melanotic hyperpigmentation in newly diagnosed HIV-seropositive patients: a nested case-control study

Objective. Oral melanotic hyperpigmentation (OMH) in patients with human immunodeficiency virus (HIV) infection has been attributed to the use of antifungal or antiretroviral drugs, as well as HIV-induced cytokine dysregulation. This research aimed to determine the relationship between immunosuppression and cytokine dysregulation in newly diagnosed HIV-seropositive subjects with OMH. Study Design. The study was conducted among newly diagnosed HIV-seropositive patients at the Infectious Disease Clinic, Ibadan, Nigeria. The cases were patients with OMH matched for age and sex with control subjects without OMH. CD4(+) count and cytokine levels (interleukin-6 and tumor necrosis factor-alpha) were compared between the cases and control subjects. SPSS version 21 software was used for data analysis. Results. Seventy newly diagnosed HIV-seropositive patients were studied, which comprised of 35 cases and 35 control subjects. The median CD4(+) counts for cases and control subjects were 174 cells/mm(3) (interquartile range [IQR], 57-250) and 324 cells/mm(3) (IQR, 107-424), respectively. Severe immunosuppression (CD4(+) count, <= 200 cells/mm(3)) was found in over half of the study participants, being more prevalent among the cases than among the control group (P = .019). Serum cytokine levels did not significantly vary between the cases and control subjects. Conclusions. There was a significant association between HIV-OMH and severe immunosuppression in the newly diagnosed HIV-seropositive patients.