Introduction As of december 1995, nine hundred and thirty-six children were identified to be HIV-1 infected by perinatal vertical transmission and over 3600 are at risk in Italy. AIDS cases were 471 (50.3% of infected) and 288 children died. The survival rates are 72.3% at five years and 50.0% at ten years (Italian Register of Pediatric HIV Infection, XII-1995 Workshop). It is well known that oral lesions can develop in HIV-serumpositive children but few data exist on their prevalence, progression and prognostic value. The presence of oral pathosis could contribute to worsen the general status of HIV+ children and fasten the onset of a poor prognosis. This study investigates the presence of oral lesions and conditions as related with CD4+ lymphocyte counts in a small cohort of patients followed at the HIV+ Children Care Center, V Department of Pediatrics, University of Milano. Patients and Methods 21 HIV-serumpositive children, 12 males and 9 females were followed. 12 children were born from IVDA or ex-IVDA serumpositive mothers, 2 children from heterosexually infected mothers and 7 from infected mothers by undetermined causes. The monthly or bi-monthly clinical appointment at the HIV+ Children Care Center comprised general and neurological examination, blood analysis with cell counts, Ig levels and lymphocyte subpopulations counts. Oral examinations were performed quarterly by one trained examiner (S.A.). HIV-related oral lesions and conditions were diagnosed and classified according to the revised criteria of the EEC-Clearinghouse and WHO-Collaborating Centre on Oral Manifestations of HIV (1993). Collected data have been entered into a personal computer and statistics has been performed by non-parametric tests and the Kaplan-Meier method. Results The follow-up periods were 7 to 53 months long (mean 29.1 mos.). Patients entered the trial at 0 to 84 months of age (mean: 23.3 mos. ±26.5). At the end of the study patients were aged 17 to 129 months (mean: 52.4 mos. ±32.9). 6 patients (#5,#9,#12,#13,#17,#18) died during the follow-up period (age of death: 24 to 108 mos., mean: 56.7 mos. The mean CD4+ cell count at the beginning of the oral follow-up was 958.5/mm3± 608.9 sd (range 75÷2640/mm3) and the final value was 453.7/ mm3±554.3 sd (range 5÷1875/mm3). 15 patients (71.4%) had at least one oral condition (4 of them died). 8 children developed a second HIV-related oral disease. Totally, 13 pseudomembranous candidiasis, 3 angular cheilitis, 3 oral hairy leukoplakia, 3 aphtous ulcerations and 1 erythematous candidiasis (Fig.1 & Fig.2) were detected. Oral lesions have been detected 2 to 76 months from birth (mean age 28.6 mos. for the first condition and 41.7 mos. for the second one). See table and graphs for details. CD4+ counts at the time of diagnosis of the first oral condition were significatively lower (p=0.01,Wilcoxon test) than initial counts; the mean value was 564.3/mm3±598.7 sd (range 12÷1890/mm3). The depletion of CD4+ cells from beginning to the end of follow-up was significatively higher in patients who developed oral lesions (mean: - 676.5/mm3, p=0.004, Wilcoxon test). 53.3 % of patients with one oral lesion had CD4+ lymphocyte counts below 500 cell/mm3 at the time of the diagnosis, whereas only 33.3% of those without lesions had such figures at the end of the study. Kaplan-Meier estimates of time to develop CD4+ cell counts below 500/mm3 were calculated. Observations were censored at CD4+ count = 500. The presence of oral lesions discriminates all children whose CD4+ lymphocytes falled below 500 by the 32d month, whereas only in the 60% of patients without lesions such depletion occurred within that period.

HIV-related oral lesions in a cohort of HIV infected children / S. Abati, G.V. Zuccotti, A. Carrassi. ((Intervento presentato al 3. convegno Third International Workshop on the Oral Manifestations of HIV Infection tenutosi a London nel 1996.

HIV-related oral lesions in a cohort of HIV infected children

S. Abati
Primo
;
G.V. Zuccotti
Secondo
;
A. Carrassi
Ultimo
1996

Abstract

Introduction As of december 1995, nine hundred and thirty-six children were identified to be HIV-1 infected by perinatal vertical transmission and over 3600 are at risk in Italy. AIDS cases were 471 (50.3% of infected) and 288 children died. The survival rates are 72.3% at five years and 50.0% at ten years (Italian Register of Pediatric HIV Infection, XII-1995 Workshop). It is well known that oral lesions can develop in HIV-serumpositive children but few data exist on their prevalence, progression and prognostic value. The presence of oral pathosis could contribute to worsen the general status of HIV+ children and fasten the onset of a poor prognosis. This study investigates the presence of oral lesions and conditions as related with CD4+ lymphocyte counts in a small cohort of patients followed at the HIV+ Children Care Center, V Department of Pediatrics, University of Milano. Patients and Methods 21 HIV-serumpositive children, 12 males and 9 females were followed. 12 children were born from IVDA or ex-IVDA serumpositive mothers, 2 children from heterosexually infected mothers and 7 from infected mothers by undetermined causes. The monthly or bi-monthly clinical appointment at the HIV+ Children Care Center comprised general and neurological examination, blood analysis with cell counts, Ig levels and lymphocyte subpopulations counts. Oral examinations were performed quarterly by one trained examiner (S.A.). HIV-related oral lesions and conditions were diagnosed and classified according to the revised criteria of the EEC-Clearinghouse and WHO-Collaborating Centre on Oral Manifestations of HIV (1993). Collected data have been entered into a personal computer and statistics has been performed by non-parametric tests and the Kaplan-Meier method. Results The follow-up periods were 7 to 53 months long (mean 29.1 mos.). Patients entered the trial at 0 to 84 months of age (mean: 23.3 mos. ±26.5). At the end of the study patients were aged 17 to 129 months (mean: 52.4 mos. ±32.9). 6 patients (#5,#9,#12,#13,#17,#18) died during the follow-up period (age of death: 24 to 108 mos., mean: 56.7 mos. The mean CD4+ cell count at the beginning of the oral follow-up was 958.5/mm3± 608.9 sd (range 75÷2640/mm3) and the final value was 453.7/ mm3±554.3 sd (range 5÷1875/mm3). 15 patients (71.4%) had at least one oral condition (4 of them died). 8 children developed a second HIV-related oral disease. Totally, 13 pseudomembranous candidiasis, 3 angular cheilitis, 3 oral hairy leukoplakia, 3 aphtous ulcerations and 1 erythematous candidiasis (Fig.1 & Fig.2) were detected. Oral lesions have been detected 2 to 76 months from birth (mean age 28.6 mos. for the first condition and 41.7 mos. for the second one). See table and graphs for details. CD4+ counts at the time of diagnosis of the first oral condition were significatively lower (p=0.01,Wilcoxon test) than initial counts; the mean value was 564.3/mm3±598.7 sd (range 12÷1890/mm3). The depletion of CD4+ cells from beginning to the end of follow-up was significatively higher in patients who developed oral lesions (mean: - 676.5/mm3, p=0.004, Wilcoxon test). 53.3 % of patients with one oral lesion had CD4+ lymphocyte counts below 500 cell/mm3 at the time of the diagnosis, whereas only 33.3% of those without lesions had such figures at the end of the study. Kaplan-Meier estimates of time to develop CD4+ cell counts below 500/mm3 were calculated. Observations were censored at CD4+ count = 500. The presence of oral lesions discriminates all children whose CD4+ lymphocytes falled below 500 by the 32d month, whereas only in the 60% of patients without lesions such depletion occurred within that period.
1996
Settore MED/28 - Malattie Odontostomatologiche
Settore MED/38 - Pediatria Generale e Specialistica
HIV-related oral lesions in a cohort of HIV infected children / S. Abati, G.V. Zuccotti, A. Carrassi. ((Intervento presentato al 3. convegno Third International Workshop on the Oral Manifestations of HIV Infection tenutosi a London nel 1996.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/193215
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