TIME FROM HIV SEROCONVERSION TO ORAL CANDIDIASIS OR HAIRY LEUKOPLAKIA AMONG HOMOSEXUAL AND BISEXUAL MEN ENROLLED IN 3 PROSPECTIVE COHORTS

Objectives: We evaluated time from HIV seroconversion to diagnosis of two common oral lesions associated with HIV infection and disease progression. Design: Oral examinations were performed on homosexual and bisexual men enrolled in prospective cohorts. Setting: Homosexual and bisexual men were followed in three epidemiologic cohort studies in San Francisco, California, USA. Participants: Data were evaluated from 80 men with well-defined dates of HIV seroconversion from 1984 through 1991. Main outcome measures: We determined the cumulative incidence of oral candidiasis and hairy leukoplakia after HIV seroconversion. Results: Four per cent of men developed oral candidiasis within 1 year after HIV seroconversion, 8% within 2, 15% within 3, 18% within 4, and 26% within 5 years. Nine per cent developed hairy leukoplakia within 1 year, 16% within 2, 25% within 3, 35% within 4, and 42% within 5 years. The median CD4+ count was 391 x 10(6)/l when oral candidiasis was first reported and 468 x 10(6)/l when hairy leukoplakia was first reported. Conclusions: Oral candidiasis or hairy leukoplakia appeared in a significant proportion of HIV-infected homosexual and bisexual men. These lesions occurred relatively soon after HIV seroconversion, typically before AIDS. Evaluation of HIV-infected individuals for these lesions has many potential clinical and research benefits, including the possible use of oral lesions as primary end-points in clinical trials.