All ETDs from UAB

Advisory Committee Chair

Craig M Wilson

Advisory Committee Members

Inmaculada Aban

Pauline Jolly

Jeffrey Hill

Sten Vermund

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

The true nature of the association of oral lesions (OL) and gold standards of HIV progression, CD4+ T cell counts (CD4) and HIV-1 RNA viral load (VL), is not completely clear, especially when patients are on antiretroviral therapy (ART). Our aim was to assess the association between OL and virologic failure among HIV/AIDS patients on ART. We conducted a retrospective study of 744 HIV patients who entered care between 2000 and 2006 at the UAB 1917 Clinic. Data was collected for 2 years after enrollment. Prevalence of OL was 35.8%. Oropharyngeal candidiasis (OPC) was the most prevalent OL (74.9%). Among 374 descriptions of OL, 183 represented new cases while 57 were recurrences. The person-visit incidence rate for any OL in our sample was 0.02. Individuals with OL were more likely to have VL =>10,000 when compared to patients with no OL only at baseline and 12 months, (p<0.01 for both times). The difference from time to virologic failure was statistically significant (log-rank 8.10, p<0.01) between patients with baseline OL (mean = 17 months, 95% CI 16, 18) and patients without baseline OL (mean = 19 months, 95% CI 18, 20). Patients who were African-American (HR 1.356; 95% CI = 1.045-0.759), ART experienced (HR 2.298; 95% CI = 1.743-3.030), had a diagnosis of mental disorder (HR 1.410; 95% CI = 1.078-1.843), and had high baseline VL (HR 2.82; 95%CI = 1.661-3.137), were more likely to have a shorter time to virologic failure after the first six months of HIV treatment. Baseline OL was not retained as a predictor in the final model. OL had a moderate PPV for concurrent virologic failure at 6 months (45.5%) and 18 months (33.3%), but a strong PPV at 12 months (80.0%) and 24 months (100.0%). Our results did not fully support the hypothesis of OL as a single accurate clinical marker for virologic failure among ART users. Further studies, are suggested before considering these criteria as a single clinical surrogate for determining treatment failure.

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