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Abstract Objectives This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. Methods A cross-sectional study was conducted on a sample of 161 patients attending the… All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. Results Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p = 0.04), as well duration of treatment (p = 1.53e-3) and age (p = 0.02). Hyperpigmentation was related to race (p = 0.01) and smoking (p = 1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [−2.27 to −0.25]; p-value = 0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR = 8.47 [1.18-3.10], p = 1.31e-5), without race or type and duration of treatment. Conclusion Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. Level of evidence Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").
RESUMO
Introdução: O câncer bucal é apontado como um problema de saúde relevante e apresenta alta taxa de incidência e mortalidade. O consumo de tabaco e álcool são considerados os principais fatores de risco para sua ocorrência. Apesar dos avanços relacionados a detecção, diagnóstico e tratamento, grande parte dos pacientes ainda é diagnosticada com a doença em estágio avançado. Objetivo: Estabelecer os principais fatores associados ao atraso no diagnóstico do câncer bucal. Material e Métodos: Foram pesquisados artigos nas bases de dados MEDLINE/PubMed, SciELO e Lilacs, com os descritores: delayed oral cancer; delayed diagnosis oral cancer; oral cancer young patients; e HPV oral cancer patients. Como critérios de inclusão, foram delimitados artigos completos e disponíveis integramente. Publicações não relacionadas a delimitação do tema e ao objetivo do estudo foram excluídas. Resultados: Foram encontrados 513 artigos, dos quais 118 foram lidos na íntegra e 96 por fim selecionados, conforme critérios de inclusão e exclusão. Os dados indicaram que o atraso no diagnóstico do câncer bucal é frequente e relacionado ao atraso pelo paciente, atraso pelo profissional de saúde e atraso no tratamento, com destaque ao atraso pelo paciente. Conclusão: O diagnóstico precoce é o meio mais eficaz de reduzir as taxas de mortalidade e melhorar o prognóstico e qualidade de vida de pacientes com câncer bucal. Dessa forma, estratégias que objetivam a redução de diagnósticos realizados tardiamente devem ser consideradas.
Introduction: Oral cancer is identified as a relevant health problem and has a high incidence and mortality rate. Tobacco and alcohol consumption are considered the main risk factors for its occurrence. Despite advances related to detection, diagnosis and treatment, a large proportion of patients are still diagnosed with the disease at an advanced stage. Objective: To establish the main factors associated with delays in the diagnosis of oral cancer. Material and Methods: Articles were searched in the MEDLINE/PubMed, SciELO and Lilacs databases, with the descriptors: delayed oral cancer; delayed diagnosis of oral cancer; oral cancer young patients; and oral HPV cancer patients. As inclusion criteria, complete and fully available articles were delimited. Publications not related to the delimitation of the topic and the objective of the study were excluded. Results: 513 articles were found, of which 118 were read in full and 96 were finally selected, according to inclusion and exclusion criteria. The data indicated that delays in diagnosing oral cancer are frequent and related to delays by the patient, delays by healthcare professionals and delays in treatment, with emphasis on delays by the patient. Conclusion: Early diagnosis is the most effective way to reduce mortality rates and improve the prognosis and quality of life of patients with oral cancer. Therefore, strategies that aim to reduce late diagnoses should be considered.