[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

7577 ORAL MUCOSAL ALTERATIONS IN HIV-I INFECTED
INDIVIDUALS - A CYTOLOGIC STUDY. C-K. Yeh,
R. Katz, A-M Wilder, P.C. Fox, B.J. Baum,
CIPCB, NIDR; NCI; NIH, Bethesda, MD USA.
Objective. Saliva, the oral mucosal barrier and the
commensal oral flora act in concert to protect the oral
cavity from disease. We have reported previously
certain specific salivary gland alterations in HIV-I
infected individuals. The purpose of this study was to
assess the oral mucosa by cytologic examination for
signs of infection and loss of integrity. Methods.
Patients were HIV-I antibody seropositive, homo- or
bisexual males. Clinically, patients were classified
in Groups II, III and IV D by CDC criteria. Controls
were age matched, healthy men. Routine cytological
smears were obtained from the tongue, buccal mucosa and
any oral mucosal lesions, and were stained with both a
Papanicoloau and PAS method. The presence of candidal
hyphae, viral inclusions and epithelial cell histologic
changes were recorded. Results. Candidal hyphae were
more frequently observed in HIV-I infected individuals
(7/18, 38%) than in controls (2/26,8%). 5 patients
presented with oral mucosal lesions, 3 of which were
white and contained hyphae. Epithelial cell
abnormalities (reactive atypia and hyperkeratosis) were
seen in 6/18 HIV-I infected individuals as compared
with 2/26 controls. No viral inclusions were found.
Conclusion. Our data demonstrate a high incidence of
oral mucosal alterations, manifested by candidal
invasion and epitheleal abnormalities, in normal
appearing sites of HIV-I infected individuals. This
suggests that oral defense factors are compromised
early in this infection and may explain, in part, the
numerous oral lesions in these individuals.

7578 ORAL MANIFESTATIONS ASSOCIATED WITH
HIV-INFECTION
Angelika A. Langford*, P Reichart*, HD Pohle**
*Dept. for Oral Surgery (North) and *Dept. Int. Med. II,
Free University Berlin
During a time of 4 years a total of 260 HIV-positive
patients have been examined (HIV+: n=6o, ARC: n=85,
IJDS: n=117). Oral lesions were classified according to the
classification proposed at the EEC meeting in Copenhagen
(Sept. 1986). i. Neoplasms: oral KS: n=23 (male
homosexuals; average age: 38,6 years). 2. Fungal infections:
a) Pseudomembraneous type (n=82). b) erythematous
(atrophic) form (n=39). c) hyperplastic form (n=52). d)
papillary form (n=i6). 3. Bacterial infections: a) Necrotising
gingivitis (NUG) (n=I6). b)Progressive periodontitis (n=38).
4. Viral infections: a) HSV induced: Herpetic stomatitis
(n=14). b) VZV induced: Oral Zoster (n=4). c) HPV induced:
Multiple verruca vulgaris (n=2). d) EBV induced: Hairy
leukoplakia (n=7o). e) CMV induced (?): oral ulceration
(n=i). 5. Lesions of unknown etiology: a) Recurrent
aphthous ulceration (n=5). b) Progressive ulceration (n=3). c)
Toxic epidermolysis (n=2). d) Involvement of cranio-facial
nerves (n=3). e) Melanin-pigmentation of oral mucosa (n=7).
f) Delayed woundhealing (n=i5)- g) Idiopathic
thrombocytopenia (n=3). h) Enlargement of salivary glands
(n=2).
The oral findings are correlated to patients immunological
stage and the progression of AIDS symptoms. The influence
of different medications (Zidovudine, Acyclovir, alpha-2 -Interferon) on occurence or regression of oral
manifestations is evaluated.

Notes:

7579
LOCAL TREATMENT OF HIV-ASSOCIATED
PERIODONTAL DISEASES.
M. Grassi*, C.A. Williams**,
J.R. Winkler**, P.A. Murray**
* University of Berne, Switzerland
** University of California, San Francisco
Objective. Evaluation of three local treatment modalities of HIV-associated periodontal diseases.
Methods. 30 patients seropositive for HIV-antibody were
treated with conventional therapy (oral hygiene instructions, scaling and root planing).6 patients were treated
in addition with 10% povidone iodine (Betadine) irrigation, and 10 patients by 0,12% chlorhexidine (Peridex)
rinses. The examination was repeated at 1 and 3 months.
Results. Patient treated by conventional therapy alone
showed no improvement in any clinical assessments, and
mean attachment loss increased 0,5 mm during the 3-month
period. Patients treated with Betadine irrigation showed
similar results, but benefitted from Betadine's topical
anesthetic and hemostatic effects during scaling and
root planing. Peridex rinses showed significant improvement in all clinical parameters, including complete
resolution of spontaneous bleeding.
Conclusions. Th use of 0.12% chlorhexidine as adjunctive
to local treatment of HIV-associated periodontal diseases
is recomended.

7580 ORAL MANIFESTATIONS OF HIV INFECTION IN A
COHORT OF HOMOSEXUAL AND BISEXUAL MEN
Joseph Engelman*, D Greenspan**, AR Lifson*, D Feigal**,
NA Hessol*, R Maus*, GW Rutherford*, JS Greenspan**.
*San Francisco Dept. of Public Health, CA. **Oral AIDS
Center, Univ of California, San Franicsco, CA, U.S.A.
Objective. To determine the prevalence of oral lesions in
a cohort of homosexual and bisexual men and to analyze
the association of oral lesions with duration of HIV
infection and immunologic status.
Methods. 315 homosexual and bisexual men enrolled in a
natural history study of HIV infection had oral examinations and tests for HIV antibody and T-lymphocyte subsets
during 1987. Data were analyzed using t-test, chi-square,
chi-square test for trend, and linear regression.
Results. 44 (35%) of 125 infected men and 7 (3.7%) of 190
uninfected men had oral lesions (p<.001). Hairy leukoplakia (HL) and oral candidiasis (OC) were found only in
infected men. Among infected men, 27 (22%) had HL, 17
(17%) had OC, 14 (11%) had gingivitis/periodontitis (GP),
and 1 (0.8%) had KS. 14 (11%) had more than 1 lesion. Infected men with lesions had lower T4-cell counts (mean=
352/mcl) than infected men without lesions (mean=651/mcl),
p<.001). 80 infected men had known dates of seroconversion between 1978-83. The prevalence of oral lesions in
this group was statistically associated with duration of
HIV infection (p=.002). In 23 men with oral lesions and
known dates of seroconversion, there was no correlation
between T4 level and duration of infection (R2=.002).
Conclusion. The prevalence of oral lesions is significantly greater in HIV-infected men than in non-infected
men. The most common lesions are HL, OC, and GP. Low T4
counts and increased duration of infection are both independently associated with the presence of oral lesions.

319