ORIGINAL ARTICLE HIV-Related Oral Lesions, Demographic Factors, Clinical Staging and Anti-Retroviral Use Velia Ramı ´rez-Amador, a Gabriela Anaya-Saavedra, a Juan J. Calva, b Tirso Clemades-Pe ´rez-de-Corcho, c Carlos Lo ´pez-Martı ´nez, c Imelda Gonza ´lez-Ramı ´rez, a and Juan Sierra-Madero b a Universidad Auto ´noma Metropolitana2Xochimilco, Me ´xico D.F., Me ´xico b Instituto Nacional de Ciencias Me ´dicas y Nutricio ´n, Salvador Zubira ´n, Me ´xico D.F., Me ´xico c Clı ´nica Especializada Condesa, Me ´xico D.F., Me ´xico Received for publication November 16, 2005; accepted January 25, 2006 (ARCMED-D-05-00472). Background. The aim of the present study was to compare the prevalence of HIV-related oral lesions (HIV-OL) between two health centers for HIV in Mexico City and to analyze the factors that, in addition to combined antiretroviral therapy (CART) and low CD4 1 , may be associated with possible differences in prevalence. Methods. A cross-sectional observational study was performed between January 2000 and February 2003 at the Instituto Nacional de Ciencias Me ´dicas y Nutricio ´n Salvador Zubira ´n (INCMNSZ), a specialized referral center for HIV/AIDS patients and the Clı ´nica Especializada Condesa (CEC), a primary care center for HIV-infected individuals without social security insurance. A consecutive sample of HIV-infected individuals had an oral examination based on established clinical criteria. Demographic, clinical and laboratory data were obtained. Independent association of each factor with specific HIV-OL was assessed by logistic regression modeling. Results. Eight hundred fifty individuals were examined (INCMNSZ: 479; CEC: 371). Hairy leukoplakia (HL), periodontal disease (PD) and Kaposi’s sarcoma (KS) were inde- pendently associated with the study site [odds ratio (OR) 5 1.7 (95% confidence interval (CI): 1.1–2.4), OR 5 4.2 (95% CI: 1.3–13), OR 5 10.1 (95% CI: 2.7–38.2), respec- tively], being more frequent in CEC patients. HL was independently associated with men having sex with men OR 5 1.7 (95% CI: 1.1–2.8). All HIV-OL were independently associated with CD4 1 counts and, with the exception of PD and KS, with time under CART. Conclusions. The present comparative study showed that several factors were associated with a difference in prevalence of oral lesions found in two AIDS clinics located in Mex- ico City. Severe immune suppression, CART duration and the study site were associated with HIV-OL. Further investigation into factors such as socioeconomic determinants associated with HIV-OL is warranted. Ó 2006 IMSS. Published by Elsevier Inc. Key Words: HIV, Oral lesions, Oral candidiasis, Hairy leukoplakia, Risk factors. Introduction Since the introduction of highly active antiretroviral ther- apy (HAART) in 1996, the incidence of most AIDS-defin- ing illnesses, opportunistic infections and Kaposi’s sarcoma (KS) has declined (1–3). Similarly, a changing pattern in the overall prevalence of HIV-related oral lesions (HIV- OL) related to the use of HAART (4–8) has been observed. A decrease in the prevalence of oral candidiasis (OC), hairy leukoplakia (HL) and HIV-associated periodontal disease (PD) in adults has been noted (4,5,9,10), whereas in some series an increase in benign human papilloma virus-associ- ated oral lesions and HIV-related salivary gland disease has been reported (4,9–11). Address reprint requests to: Velia Ramı ´rez-Amador, Camino Sta. Teresa 277-9, Col. Parques del Pedregal, 14010 Me ´xico D.F. Me ´xico; E-mail: rava1863@correo.xoc.uam.mx; veliaram@hotmail.com 0188-4409/06 $–see front matter. Copyright Ó 2006 IMSS. Published by Elsevier Inc. doi: 10.1016/j.arcmed.2006.01.002 Archives of Medical Research 37 (2006) 646–654