PROGNOSTIC-SIGNIFICANCE OF ORAL LESIONS IN CHILDREN WITH PERINATALLY ACQUIRED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objective.-To assess the prevalence and prognostic significance of oral lesions in children with human immunodeficiency virus infection. Design.-Clinical cohort study. Setting.-Children's Hospital Center at Jackson Memorial Hospital, Miami, Fla. Participants.-Ninety-nine children with perinatally acquired human immunodeficiency virus infection examined longitudinally for oral lesions. Interventions.-None. Measurements/Main Results.-Presence of oral lesions was determined by a pediatrician who had been trained in the diagnosis of oral lesions. The cumulative prevalence of lesions was 72% for oral candidiasis, 47% for parotid enlargement, and 24% for herpes simplex. The median time from birth to development of a lesion was 2.4 years for candidiasis, 4.6 years for parotid enlargement, and 5 years for herpes simplex. The median time from lesion to death was 3.4 years for patients with candidiasis, 5.4 years for patients with parotid enlargement, and 4.3 years for patients with herpes simplex. In a time-dependent proportional-hazards model, oral candidiasis was associated with a more rapid rate of progression to death (relative hazard, 14.2; 95% confidence interval, 4.8 to 41.8), while parotid enlargement was associated with a less rapid rate of progression to death (relative hazard, 0.38; 95% confidence interval, 0.16 to 0.88) and herpes simplex was unrelated to the rate of progression (relative hazard, 1.3; 95% confidence interval, 0.5 to 3.1). Conclusions.-The presence of oral candidiasis and parotid enlargement confer important prognostic information and should be incorporated into decisions regarding therapy for HIV-infected children.