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A Longitudinal Analysis

Caroline H. Shiboski, DDS, MPH; Joan F. Hilton, ScD, MPH; John M. Neuhaus, PhD; Alison Canchola, MS; Deborah Greenspan, BDS, DSc; University of California, San Francisco Oral AIDS Center Epidemiology Collaborative Group

Arch Intern Med. 1996;156(19):2249-2254.

Abstract
Background
Because human immunodeficiency virus (HIV) infection affects an increasing number of women in the United States, we investigated the role played by gender in the occurrence of HIV-related oral conditions.

Methods
As part of a 4-year prospective study of 3 epidemiological cohorts, oral and physical examinations (including blood tests) were performed on HIV-infected men (n=200) and women (n=218) at 6-month intervals. Our outcome variables included oral conditions commonly associated with HIV infection: hairy leukoplakia, candidiasis, ulcers, warts, non-Hodgkin lymphoma, Kaposi sarcoma, and parotid enlargement.

Results
Only hairy leukoplakia, candidiasis, and ulcers were observed. The occurrence of hairy leukoplakia and candidiasis was higher in men (22% and 24%, respectively) than in women (9% and 13%, respectively) during the study period. A regression model for longitudinal data (generalized estimating equation) disclosed that the odds of having hairy leukoplakia were 2.5 times higher for men than for women, after controlling for CD4⁺ cell count, race, and injecting drug use (95% confidence interval, 1.34-4.76; P=.003). Length of follow-up did not confound this association. A weaker association was found between the occurrence of oral candidiasis and gender (adjusted odds ratio, 1.85; 95% confidence interval, 1.0-3.43; P=.05).

Conclusions
In this sample of HIV-infected adults, we found that men were significantly more likely to have hairy leukoplakia than were women. The hairy leukoplakiagender association merits further investigation, because it may be related to a gender difference in the mode of expression of Epstein-Barr virus.

Arch Intern Med. 1996;156:2249-2254

Author Affiliations
From the Departments of Stomatology (Drs Shiboski and Greenspan and Ms Canchola) and Epidemiology and Biostatistics (Drs Hilton and Neuhaus), University of California, San Francisco. Members of the UCSF Oral AIDS Center Epidemiology Collaborative Group are listed at the end of the article.

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