Increasing cd8⁺ t lymphocytes predict subsequent development of intraoral lesions among individuals in the early stages of infection by the human immunodeficiency virus

Summary: Determining the progression of human immunodeficiency virus (HIV) type 1 infection based on cellular and clinical markers has become increasingly important. Although a number of studies have shown a relationship between the presence of certain oral lesions and progression to AIDS, few data exist regarding the association with T lymphocyte counts. In this study, the question of whether intraoral lesions preceded or were the consequences of changes in T lymphocyte counts was examined. A total of 116 HIV-infected patients participating in two randomized double-blind placebo-controlled trials of zidovudine at the University of Minnesota AIDS Clinical Trials Unit (ACTU) were enrolled in a prospective dental study. Patients were examined for the presence of hairy leukoplakia, candidiasis, herpes simplex, herpes zoster, aphthae, atypical gingivitis, HIV-associated periodontitis, and necrotizing ulcerative gingivitis, as well as other oral lesions, every 3 months for a maximum of four examinations over a 1-year period. T lymphocyte counts before and after each patient’s oral examination were obtained. No significant differences were found at examination 1 for differences in gender, race, age, education, tobacco smoking status, ethanol consumption habits, duration in ACTU drug protocol, duration in dental study protocol, or mean T lymphocyte counts between individuals with or without oral lesions at any time in the dental study. The relationships between T lymphocyte counts before and after each dental examination as well as the presence or absence of an oral lesion at that examination were analyzed using maximum likelihood estimation techniques. The strongest relationship was found between elevated average number of CD8⁺ T lymphocytes before a dental examination and the appearance of oral lesions at that examination (p = 0.04). Changes in CD4⁺ T lymphocytes were not found to be associated with the presence of oral lesions. Assessing trends in numbers of CD8⁺ T lymphocyte counts, in addition to CD4⁺ counts, may provide information useful for effective management of oral manifestations of HIV-infected patients, as well as monitoring the clinical course of the infection.