HIV/related tumors and other lesions of the oral cavity

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University of Dar es Salaam
Background: Oral lesions and tumors are often an early manifestation of human immunodeficient virus (HIV) infection and can be identified in about 40% of all HIV infected patients and in over 90% of acquired immunodeficient syndrome (AIDS) patients. Statistical data is not available in Tanzania and little has been done in sub-Saharan Africa to give an in-depth analysis into the situation. This study has established such baseline data for oral tumors and other lesions in order to help plan for subsequent improvement in diagnosis and therapeutic modalities, predict prognosis, thus improving quality of life of patients, considering the current availability of anti-retroviral drugs (ARV-drug) and tumor therapy. This will also provide baseline data for future research. Objectives: To determine the frequency, distribution, histological and clinical characteristics of oral tumors and other lesions of oral cavity in relation with HIV infection at Muhimbili National Hospital (MNH), from 1998 to 2003. Also to classify some of the tumors and demonstrate the viral etiological agents, particularly in HIV-related oral Kaposi's sarcoma by immunohistochemistry. Study design: A descriptive retrospective and prospective analytical study. Materials and methods: This study included 1302 patients with oral tumors and other oral lesions who attended at MNH between 1998 and 2003. Materials were obtained retrospectively from records, archival tissue blocks, slides, serological and histological reports. Also Blood for ELISA, and tissue biopsies were collected from patients prospectively . They were analyzed for histological diagnosis, site of biopsy, histological grade, and HIV sero-status and immunohistochemical characteristics. Demographic information such as age and sex was also collected. Results: During the span of 6 years, 1302 cases were recruited in the study in which males were 623 (47.8%) and female 679 (52.2%). The age ranged from 1 to 90 years with mean of 38.26 years (SD= 19.2). Proportion of oral malignant tumors was 39.1% (n=509). Carcinomas were the commonest type of oral tumors in the present study constituting 23.9% (n=311) of all oral lesions, followed by inflammatory conditions 17.3% (n=225). There were 242 cases of oral squamous cell carcinoma (OSCC) constituting 18.6% of all oral tumors and was foW1d to occur more frequently above 40 years, with male to female ratio of 1.1:1. Oral Kaposi's sarcoma (OKS) cases were 93, of which 78.5% (n=73) were females and most of OKS was seen between 21-40 years of age. Palate was the site of predilection for OKS in 39.8% (n=37) of the cases. Burkitt 's lymphoma (BL) was the commonest oral Non-Hodgkin's lymphoma (NHL) 62.5% (n=20) and most of the patients 95% (n=19) were at age of less than 20 years. Only one case of primary oral Hodgkin's Lymphoma (HL) was seen in the present study HIV sero-status was known in only 113 cases (8.7%) out of the 1302 recruited patients whereby 51 cases (45.2%) were sero-positive. Remarkably, of the 39 OKS cases screened for HIV, 38 (97.4%) were sero-positive. Of 28 cases of oral inflammatory conditions screened for HIV status, 9 (32.5%) were associated with HIV infection. In OSCC, 21 cases were screened for HIV and only one case (4.8%) was sero-positive and in lymphoma only two cases were screened for HIV and all were sero-negative. Immunohistochemistry showed that, all BL and NHL of oral cavity were of B-cell origin. All KS cases expressed a "Latency-associated nuclear antigen" (LANA) in the spindle cells. Conclusion: The result of this study has shown that, 97.4% of OKS and about a third of all cluonic non-specific inflammatory conditions of the oral cavity are associated with HIV infection. Additionally, there was a steady annual increase of oral tumors and other lesions in this study, and therefore, oral lesions can be considered as potential public health problem in this era of increasing incidence of HIV/AIDS in Tanzania. Recommendations: All patients with histological diagnosis of OKS and those with non-specific chronic inflammation of oral cavity need to be screened for HIV infection, to rule out the causal association of these lesions and HIV infection.
Available in print form, East Africana Collection, Dr. Wilbert Chagula Library, Class mark (THS EAF RC 254.6M6)
AIDS disease, Tumors
Mosha, I.J (2005) HIV/related tumors and other lesions of the oral cavity.Master dissertation, University of Dar es Salaam, Dar es Salaam.