Advertisement

Relationship between CD4+ count, serum inflammatory cytokines, and oral melanotic hyperpigmentation in newly diagnosed HIV-seropositive patients: a nested case-control study

Published:October 21, 2021DOI:https://doi.org/10.1016/j.oooo.2021.10.009

      Objective

      Oral melanotic hyperpigmentation (OMH) in patients with human immunodeficiency virus (HIV) infection has been attributed to the use of antifungal or antiretroviral drugs, as well as HIV-induced cytokine dysregulation. This research aimed to determine the relationship between immunosuppression and cytokine dysregulation in newly diagnosed HIV-seropositive subjects with OMH.

      Study Design

      The study was conducted among newly diagnosed HIV-seropositive patients at the Infectious Disease Clinic, Ibadan, Nigeria. The cases were patients with OMH matched for age and sex with control subjects without OMH. CD4+ count and cytokine levels (interleukin-6 and tumor necrosis factor-α) were compared between the cases and control subjects. SPSS version 21 software was used for data analysis.

      Results

      Seventy newly diagnosed HIV-seropositive patients were studied, which comprised of 35 cases and 35 control subjects. The median CD4+ counts for cases and control subjects were 174 cells/mm3 (interquartile range [IQR], 57-250) and 324 cells/mm3 (IQR, 107-424), respectively. Severe immunosuppression (CD4+ count, ≤200 cells/mm3) was found in over half of the study participants, being more prevalent among the cases than among the control group (P = .019). Serum cytokine levels did not significantly vary between the cases and control subjects.

      Conclusions

      There was a significant association between HIV-OMH and severe immunosuppression in the newly diagnosed HIV-seropositive patients.
      To read this article in full you will need to make a payment

      References

        • Ranganathan K
        • Hemalatha R.
        Oral lesions in HIV infection in developing countries: an overview.
        Adv Dent Res. 2006; 19: 63-68
        • Greenspan D
        • Greenspan JS.
        Oral manifestations of HIV infection.
        AIDS Clin Care. 1997; 9: 29-33
        • Askinyte D
        • Matulionyte R
        • Rimkevicius A.
        Oral manifestations of HIV disease.
        Top HIV Med. 2015; 17: 143-148
        • Chandran R
        • Feller L
        • Lemmer J
        • Khammissa RAG.
        HIV-associated oral mucosal melanin hyperpigmentation: a clinical study in a South African population sample.
        AIDS Res Treat. 2016; 20168389214
        • Feller L
        • Masilana A
        • Khammissa RAG
        • Altini M
        • Jadwat Y
        • Lemmer J.
        Melanin: the biophysiology of oral melanocytes and physiological oral pigmentation.
        Head Face Med. 2014; 10: 8
        • Roberts L
        • Passmore JAS
        • Williamson C
        • et al.
        Plasma cytokine levels during acute HIV-1 infection predict HIV disease progression.
        AIDS. 2010; 24: 819-831
        • French MA
        • Cozzi-Lepri A
        • Arduino RC
        • et al.
        Plasma levels of cytokines and chemokines and the risk of mortality in HIV-infected individuals: a case-control analysis nested in a large clinical trial.
        AIDS. 2015; 29: 847-851
        • Feller L
        • Chandran R
        • Kramer B
        • Khammissa RAG
        • Altini M
        • Lemmer J.
        Melanocyte biology and function with reference to oral melanin hyperpigmentation in HIV-seropositive subjects.
        AIDS Res Hum Retroviruses. 2014; 30: 837-843
        • Blignaut E
        • Patton LL
        • Nittayananta W
        • Ranganathan K
        • Chattopadhyay A.
        A3) HIV phenotypes, oral lesions, and management of HIV-related disease.
        Adv Dent Res. 2006; 19: 122-129
        • Namakoola I
        • Wakeham K
        • Parkes-Ratanshi R
        • et al.
        Use of nail and oral pigmentation to determine ART eligibility among HIV-infected Ugandan adults.
        Trop Med Int Health. 2010; 15: 259-262
        • Sud N
        • Shanker V
        • Sharma A
        • Sharma NL
        • Gupta M.
        Mucocutaneous manifestations in 150 HIV-infected Indian patients and their relationship with CD4 lymphocyte counts.
        Int J STD AIDS. 2009; 20: 771-774
        • Sharma G
        • Oberoi S
        • Vohra P
        • Nagpal A.
        Oral manifestations of HIV/AIDS in Asia: systematic review and future research guidelines.
        J Clin Exp Dent. 2015; 7: e419-e427
        • Taiwo OO
        • Hassan Z.
        The impact of highly active antiretroviral therapy (HAART) on the clinical features of HIV-related oral lesions in Nigeria.
        AIDS Res Ther. 2010; 7: 4-9
        • Frimpong P
        • Amponsah EK
        • Abebrese J
        • Kim SM.
        Oral manifestations and their correlation to baseline CD4 count of HIV/AIDS patients in Ghana.
        J Korean Assoc Oral Maxillofac Surg. 2017; 43: 29-36
        • Abe EO
        • Adeyemi BF
        • Adisa AO
        • Okoje-Adesomoju VN
        • Awolude OA.
        Oral melanotic hyperpigmentation (OMH) among HIV sero-positive patients: a clinical study at the University College Hospital, Ibadan.
        Afr J Oral Maxillofac Path Med. 2017; 3: 9-14
        • Akase IE
        • Musa BOP
        • Obiako RO
        • Ahmad Elfulatiy A
        • Mohammed AA
        Immune dysfunction in HIV: a possible role for pro- and anti-inflammatory cytokines in HIV staging.
        J Immunol Res. 2017; 20174128398
        • Arotiba JT
        • Adebola RA
        • Iliyasu Z
        • et al.
        Oral manifestations of HIV/AIDS infection in Nigerian patients seen in Kano.
        Niger J Surg Res. 2005; 7: 176-181
        • Nanteza M
        • Tusiime JB
        • Kalyango J
        • Kasangaki A.
        Association between oral candidiasis and low CD4+ count among HIV positive patients in Hoima Regional Referral Hospital.
        BMC Oral Health. 2014; 14: 143
        • Bodhade AS
        • Ganvir SM
        • Hazarey VK.
        Oral manifestations of HIV infection and their correlation with CD4 count.
        J Oral Sci. 2011; 53: 203-211
        • Pillai AG
        • Kokila G
        • Gowda CBK.
        Grey finger nails and oral pigmentation in HIV infected patients: tool to antiretroviral treatment eligibility.
        Res J Pharm Biol Chem Sci. 2014; 5: 1838-1844
        • Tamí-Maury I
        • Coulibaly YI
        • Cissoko SS
        • Dao S
        • Kristensen S.
        First report of HIV-related oral manifestations in Mali.
        Pan Afr Med J. 2012; 11: 18
        • Eweka OM
        • Agbelusi GA
        • Odukoya O.
        Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria.
        Open J Stomatol. 2012; 2: 200-205
        • Antinori A
        • Coenen T
        • Costagiola D
        • et al.
        Late presentation of HIV infection: a consensus definition.
        HIV Med. 2011; 12: 61-64
        • Hegde M
        • Hegde N
        • Malhotra A.
        Prevalence of oral lesions in HIV infected adult population of Mangalore, Karnataka, India.
        Biodiscovery. 2012; 4: e8935
        • Watson CT
        • Glanville J
        • Marasco WA.
        The individual and population genetics of antibody immunity.
        Trends Immunol. 2017; 38: 459-470
        • Tasca KI
        • Calvi SA
        • De Souza R.
        Immunovirological parameters and cytokines in HIV infection.
        Rev Soc Bras Med Trop. 2012; 45: 663-669
        • Alawi F.
        Pigmented lesions of the oral cavity. An update.
        Dent Clin North Am. 2013; 57: 699-710
        • Nyambura Mugwe J
        • Gicheru MM
        • Mwatha J.
        Plasma cytokine profiles as predictive biomarkers of HIV and AIDS progression among HIV patients attending Nakuru Provincial General Hospital, Kenya.
        Am J Med Biol Res. 2016; 4: 20-25
        • Akase IE
        • Obiako RO
        • Musa BOP
        • Opawoye F AA
        Levels of interleukin 6 and 10 and their relationship to hematological changes in HIV treatment-naïve and treatment-experienced patients.
        Sub-Saharan Afr J Med. 2019; 6: 90-95
        • Osuji FN
        • Onyenekwe CC
        • Ahaneku JE
        • Ukibe NR.
        The effects of highly active antiretroviral therapy on the serum levels of pro-inflammatory and anti-inflammatory cytokines in HIV infected subjects.
        J Biomed Sci. 2018; 25: 88
        • Moodley A
        • Wood NH.
        HIV-associated oral lesions in HIV-seropositive patients at an HIV treatment clinic in South Africa.
        J AIDS Clin Res. 2015; 6: 422
        • Diro E
        • Feleke Y
        • Guteta S
        • Fekade D
        • Neway M.
        Assessment of risk behaviours and factors associated with oral and peri-oral lesions in adult HIV patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
        Ethiop J Health Dev. 2008; 22: 180-186
        • Admou B
        • Elharti E
        • Oumzil H
        • et al.
        Clinical and immunological status of a newly diagnosed HIV positive population, in Marrakech, Morocco.
        Afr Health Sci. 2010; 10: 325-331