Oral Microbiol Immunol 1996: 11: 371-380 Printed in Denmark • All rights resei-ved Copyright © Munksgaard 1996 &id Immunology ISSN 0902-0055 Oral diseases, mycology and periodontal microbiology of HIV-1-infected women L. J. Brady, C. Walker, G. E. Oxford, C. Stewart, I. Magnusson, W. McArthur Departments of Oral Biology and Oral Diagnostic Sciences, Periodontal Disease Research Center, Health Science Center, University of Florida, Gainesville, USA Brady LJ, Walker C, Oxford GE, Stewart C, Magnusson I, McArthur W. Oral disease, mycology and periodontal microbiology of HIV-1-infected women. Oral Microbiol Immunol 1996: 11: 371-380. © Munksgaard, 1996. HIV-1 infection is increasing more rapidly among heterosexual women. Relatively limited information is available on HIV-related oral pathoses in these individuals. To gain insight into the type and occurrence of oral lesions in this population, 25 HIV-^1 infected women including asymptomatic, symptomatic and AIDS patients were examined clinically and sampled for detection of oral yeast and characteriza- tion of their subgingival microbial flora. Sixty percent of the subjects were Afri- can-American, with 80% infected via heterosexual contact. Oral candidiasis was the most common nonperiodontal oral lesion, observed in 44% of the patients. Oral yeast was cultured from all women with candidiasis and 76% of the total subjects. Oral hairy leukoplakia was clinically diagnosed in 16% of the subjects. Clinically mild to moderate gingivitis and periodontitis were observed in 84% and 52% of the patients, respectively. Candidiasis and the presence of cultivable yeast were ob- served in patients with low, intermediate, and high CD4'*" T lymphocyte numbers. Plaque samples were collected from each subject and enumerated by predominant cultivable methods, selective media and microscopy. No differences were detected in the microflora associated with seropositive women with existing periodontitis relative to those without periodontitis or to seronegative women with periodontitis. Candidiasis was the most notable oral clitiical manifestation in the HIV-1-infected women and may be a useful chnical indicator of early immune dysfunction medi- ated by HIV-1. Key words: HIV-1; women; AIDS; oral candidiasis; mycology; microbiology; oral health; periodontitis; CD4* T lymphocytes William McArthur, Department of Oral Biology, Box 100424, University of Florida, Gainesville, FL 32610-0424, USA Accepted for publication January 18, 1996 The World Health Organization has pre- dicted that, by the year 2000, 30-40 mil- lion individuals tliroughout the world will have been infected with HIV and almost half of those will be women (60). Cases of AIDS among women of repro- ductive age has increased substantially since 1981 and represents one of the fastest-growing groups with AIDS in the United States (6). As a result of the revised case definition for AIDS among adolescents and adults (7), the number of HIV-1-seropositive women recog- nized as having AIDS i^ increasing fur- ther, with the highest median rate of in- fection among black women (14, 61). In Florida, sexual activity with multiple partners, illicit drug use, lack of access to health care, and socioeconomic dis- advantage were reported to be associ- ated with the increase in female AIDS (12). Cumulatively, women account for 15% of all reported Florida AIDS cases versus 10% in other states combined. Black women account for 72% of re- ported AIDS cases in Florida females yet comprise only 14% of the female population (12). In 1988, the death rate for black women (10.3 per 100,000) was 9 times that for white women (1.2 per 100,000) (9). There is an urgent need for information regarding the man- ifestations of HIV-1 infection in the pre- dotninantly minority female popula- tion, particularly in light of reports of gender-related differences in disease symptoms and progression (4, 19, 32) and the incidence of certain opportunis- tic infections, including esophageal can- didiasis (11, 23). There have been numerous reports to date regarding oral manifestations of HIV-1 infection, primarily in male pop- ulations. Such oral lesions include oral candidiasis, gingivitis and periodonti- tis, hairy leukoplakia, other viral infec- tions (herpes simplex virus, cytomega- lovirus, human papiiioma virus), apht- hous ulcers, thrombocytopenia purpura, salivary gland disease and oral Kaposi's sarcoma, lymphomas, and squamous cell carcinomas (3, 18, 24, 30, 33). HIV- 1-infected individuals often demon- strate oral manifestations as their first sign of disease (33), with oral candidia- sis being the most common presenting sign (20). The identification of oral le-