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Bangladesh Journal of Medical Science Vol.09 No.3 Jul’10 

1. *Dr. Rakesh Kumar Manne., M.D.S, Assistant Professor, Department of Oral Medicine & Radiology, **  

2. Dr. Ramesh Amirisetty, M.D.S, Assistant Professor, Department of Oral Medicine & Radiology, 

Chhattisghar Dental College, Rajnandagaon, Chhattisghar, India. 

3. Dr. Sravani Tippireddy., M.B.B.S, Lecturer, Department of Biochemistry,** 

4. Dr. Suneel Yadav, M.B.B.S, Medical officer, Regional Antiretroviral centre, Government general 

hospital, Nellore, Andhra Pradesh, India. 

5. Dr.Prachi Nayak., M.D.S, Assistant Professor, Oral and Maxillofacial Pathology & Microbiology,** 

6. Dr. Sushruth Nayak., M.D.S, Assistant Professor, Department of Oral and Maxillofacial Pathology & 

Microbiology,** 

**Vyas Dental College & Hospital, Jodhpur, Rajasthan, India. 

*Corresponds to: Dr. Rakesh Kumar Manne., M.D.S, Teesra Prahar Bhawan, 1
st
 A Road, Sardarpura, 

Jodhpur-342005, Rajasthan, India. Phone: +91-9680974277. Email: rmannae@rediffmail.com.

Original article

Oral manifestations associated with human immunodeficiency virus 

infection in 200 Indian patients. 

Manne RK
1
, Amirisetty R

2
, Tippireddy S

3
, Yadav S

4
, Nayak P

5
, Nayak S

6

Abstract

Objective: To determine the pattern and prevalence of oral lesions in HIV infected 200 

costal Andhra Pradesh patients. Patients and methods: the study population comprised 

200 consecutive HIV seropositive patients presented to regional ART center at Andhra 

Pradesh, India. The oral lesions were diagnosed based on clinical appearance and were 

entered in to the database for analysis. Results: 30-39 yrs age group was most commonly 

affected and 87% of the patients had acquired infection via heterosexual contact. Oral 

lesions were seen in 66% of the patients. Gingivitis (36.7% males & 33.9% females) was 

the most common lesion followed by candidiasis (21% males & 26.4% females), 

periodontitis (6.8% males & 7.5% females), pigmentation (36.7% males & 33.9% 

females), ulcers (2.7% males & 0% females) and leukoplakia (1.3% males & 0% females). 

Conclusion: The pattern of oral lesions associated with HIV infection was not markedly 

different form those reported in the literature, the prevalence of each type of lesion differ 

slightly. 

Key words: CD4 lymphocyte count, Female, HIV infections, Male, Humans. 

Introduction

Human immunodeficiency virus (HIV) 

infection is a major global health problem. 

It is estimated that number of people living 

with HIV infection in India, by the end of 

2007 is 2.31million. The prevalence rate of 

HIV infection in the country has stabilized 

over the last few years with estimated adult 

prevalence of 0.34%. Andhra Pradesh 

showed the higher prevalence rate (>1%) 

when compared with all other states (<1%) 

in India.
1

Systemic and oral lesions in HIV infection 

reflect the immune status of the patients. 

These lesions are not only important for 

the morbidity they cause but also for their 

diagnostic value in monitoring the immune 

status of the patient. Some oral lesions 

have been observed to be more rampant in 

HIV infected patients than healthy 

individuals and sometimes may be the first 

indication of the disease
2
. Furthermore, the 

appearance of some of these lesions in an 

HIV infected patient may signal the 

deterioration of the disease
3
. The aim of 

this study, therefore, is to determine the 

pattern and frequency of oral lesions 

associated with HIV infection in our 

environment in order to contribute to the 

existing data on oral HIV lesions in India.  

Patients and methods

Two hundred consecutive Patients 

attending the ART centre (Government 



RK Manne, R Amirisetty, S Tippireddy, S Yadav, P Nayak, S Nayak 

151 

regional centre for counseling and 

treatment of HIV/AIDS infection, Andhra 

Pradesh, India.) over a period of four 

months (from October 2009 to January 

2010) were the subjects of this study. A 

trained counselor confirmed sources of 

infection. Confirmation of HIV 

seropositive positive status for all the 

patients was by ELISA and western 

immunoblot. Examination of the orofacial 

tissues for each patient was performed by a 

trained medical doctor in oral 

manifestations of HIV/AIDS. Data was 

captured on an adopted WHO record form 

for oral HIV/AIDS and subjected to 

statistical analysis. 

Results

Table 1: Demographics of 200 HIV 
seropositive Patients 

Age

Group (y) 

Male 

(n=147) 

No. ( %) 

Female 

(n=53) 

No. ( %) 

<9 4(2.7) 3(5.6) 

10-19 13(8.8) 5(9.4) 

20-29 27(18.3) 9(16.9) 

30-39 56(38.0) 23(43.3) 

40-49 31(21.0) 8(15.0) 

>50 16(10.8) 5(9.4) 

Occupation

Farmer 17(11.5) 0(0.0) 

Business 7(4.7) 0(0.0) 

Driver 14(9.5) 0(0.0) 

Employed 17(11.5) 2(3.7) 

Housewife 0(0.0) 22(41.5) 

Labourer 49(33.3) 21(39.6) 

Others 43(29.2) 8(15.0) 

Table 1 shows the demographics of 200 

HIV seropositive patients. 147 (73.5%) 

were males and 53(26.5%) were females, 

giving male to female ratio of 2.8:1. The 

age of the youngest patient was 2 years and 

the age of the oldest patient was 58yrs.The 

maximum number of cases was in the 30-

39yrs age group for either genders (38.0% 

males and 43.3% females, respectively). 

Labourer (33.3%) in male and housewife 

(39.6%) in female were more infected than 

other occupations. 

Table 2 shows the source of infection. The 

main source of infection for both male and 

female (88% and 83%, respectively) was 

through the heterosexual route. Table 3 

shows the distribution of patients by CD4+ 

counts. The maximum number of male 

patients showed CD4+ count <200 (37.9%) 

and the maximum number of female 

patients showed CD4+ count 200-500 

(35.8%). 

Table 2: Distribution of HIV-positive patients 
by source of infection 

Source of 

infection

Male

(n=147) 

No. ( %) 

Female 

(n=53) 

No. ( %) 

Heterosexual 130(88.0) 44(83.0) 

Mother to child 16(10.8) 9(16.9) 

Blood transfusion 1(0.6) 0(0.0) 

Table 3: Distribution of HIV-positive patients 
by CD4+ counts 

CD4 

Count 

Male(n=145) 

No. ( %) 

Female(n=53)

No. ( %) 

<200 55(37.9) 16(30.1) 

200-500 52(35.8) 19(35.8) 

>500 38(26.2) 18(33.9) 

Table 4 shows prevalence of HIV- related 

oral lesions by gender. Of the 200 patients, 

112 patients (84 males and 28 females) 

showed 157 (117 in males and 40 in 

females) oral lesions. The most common 

lesion seen in both male and female 

patients is gingivitis (54 males and 18 

females) followed by candidiasis 

(Pseudomembranous, Erythematous and 

Angular cheilitis) (31males and 14 



Oral manifestations associated with human immunodeficiency virus infection 

152 

females). Oral pigmentation was seen in 12 

male patients and 2 female patients and all 

the pigmentations were seen on buccal 

mucosa. Male patients showed four oral 

ulcers and two leukoplakias and was not 

seen in female patients. Number of lesions 

seen in each patient was varying from 0 to 

3. 63 male patients and 25 female patients 

showed no lesions, 52 males and 17 

females showed one lesion, 31 males and 

10 females showed two lesions and 1 

patient of either genders showed three 

lesions. 

Table 4: Prevalence of HIV-related oral lesions 
by gender 

Oral lesions 

Male 

(n=147) 

No. ( %) 

Female 

(n=53) 

No. ( %) 

Candidiasis 31(21.0) 14(26.4) 

Gingivitis 54(36.7) 18(33.9) 

Periodontitis 10(6.8) 4(7.5) 

Ulcers 4(2.7) 0(0.0) 

Pigmentation 12(8.1) 2(3.7) 

Leukoplakia 2(1.3) 0(0.0) 

Others 4(2.7) 2(3.7) 

Number of lesions 

0 63(42.8) 25(47.1) 

1 52(35.3) 17(32.0) 

2 31(21.0) 10(18.8) 

3 1(0.6) 1(1.8) 

Discussion

Oral lesions of the HIV infected patients 

have been widely studied and were found 

to have diagnostic and prognostic value
4
.

This study determined the prevalence of 

oral lesions in HIV infection in the costal 

part of Andhra pradesh. It has been 

consistently shown that HIV infection 

affects young and active age groups (3
rd

and 4
th

 decades). The age of patients in this 

study agrees with the previous Indian 

study
5
. Regarding the occupation, 

Labourers and housewives were most 

commonly affected in the present study 

agrees with the study done by Singh H et 

al.
6
. The source of infection in the present 

study showed heterosexual transmission 

and is in agreement with previous 

studies
5,6

. The maximum number of male 

patients showed CD4+ count <200 (37.9%) 

and the maximum number of female 

patients showed CD4+ count 200-500 

(35.8%) and is in agreement with the 

previous studies
6,7

.

HIV infection is associated with gingival 

disease which accounted for 36.7% in 

males and 33.9% in females in the present 

study. This is comparable to the previous 

study
8
. Candidiasis has been consistently 

found to be the first recognized oral 

manifestation and sometimes the only 

initial clinical sign of the HIV infection
9
.

The prevalence rate of candidiasis in the 

present study in males is 21% and in 

females is 26.4% and is in agreement with 

the previous study
10

. Intraoral 

pigmentation was seen in 8.1% male and 

3.7% female patients. The presence of intra 

oral pigmentation in the HIV patients has 

been reported in the previous study
5
. We 

had two patients with leukoplakia and both 

patients had tobacco chewing habit.  

Conclusion

The pattern of oral lesions associated with 

HIV infection was not markedly different 

form those reported in the literature, the 

prevalence of each type of lesion differ 

slightly. The present study again 

emphasizes the usefulness of orofacial 

examination of the patients by dental 

surgeon and increases their index of 

suspicion of the infection with the 

appearance of these HIV associated oral 

lesions. 

______________ 



RK Manne, R Amirisetty, S Tippireddy, S Yadav, P Nayak, S Nayak 

153 

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