Oral lesions in paediatric patients on HAART

Abstract

The majority of children on highly active antiretroviral therapy achieve immune reconstitution and virologic control; however, there is a subset of individuals who clinically worsen on recovery. It is important to profile and characterize oral lesions in children on HAART as they may be clinical predictors of HAART failure or syndromes related to HAART. Method Two hundred and forty children aged between one month and 14 years were examined for oral lesions at the Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa. All patients were on HAART. The classification for presumptive diagnostic criteria for oral lesions was based on the review of Oral HIV/AIDS Research Alliance: updated case definitions of oral disease endpoints. Age (in months and years) at the time of examination and at diagnosis of HIV, duration of antiretroviral treatment (months), viral load ( RNH-HIV-1 per ml), CD4+ T- lymphocyte cell count (cells/mm3) and HAART regimen were recorded. Results Twenty two children out of 240 presented with either active lesions or scarring as a result of previous disease whilst on HAART, making up 9,2% prevalence rate of oral lesions in children on HAART in this cohort. This is significantly lower than prevalence rates reported by other African and International studies in a similar population. Hyperpigmentation due to HAART accounted for 50% of the intra-oral lesions detected. Other intra-oral lesions included focal 4 epithelial hyperplasia, major aphthous ulcer, recurrent herpetic infection and ulcer of unknown origin. Ten children presented with extra-oral lesions and 80% of these lesions were caused by diseases related to the Herpesviridae family. We report no significant association between presence of lesions and CD4+ T-lymphocyte count, viral load, age at diagnosis, duration of HAART and HAART regimen. However, a significant statistical association was found between presence of oral lesions and current age. The average current age of children presenting with oral lesions is 10,7 years. Six children out of 22 presenting with oral lesions, presented with discordant responses to HAART. Conclusion The prevalence of oral lesions in paediatric patients on HAART in this cohort was low. The significant association of current age and the presence of lesions may reflect the evolution of prevention of mother to child transmission strategies and more timely diagnosis of HIV and HAART implementation over the last ten years. However, further research needs to be conducted into discordant responses to HAART in the paediatric population.