1. Background The Southern United States has become the center of the HIV/AIDS epidemic in the nation. Six of the Southern states (Alabama, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina) constitute the Deep South, a region that has “some of the highest levels of poverty and uninsured individuals, factors that complicate the prevention and treatment of HIV infection”. 1 Although Alabama has been designated a moderate morbidity state with regards to HIV infection (15,683 cumulative HIV/AIDS cases as of 6/30/08), new infections are increasingly concentrated in vulnerable populations, such as African-Americans, women, and rural populations. 2,3 The epidemiology and prevalence of oral manifestations (OM) during HIV infection are comprehensively documented in the literature from the United States 4-8 However, the profile and risk factors for OM in those individuals initiating HAART remains understudied in the Southeast of the US, 9 region of increasing HIV prevalence. The purpose of this study, was to investigate clinical and socio-demographic factors associated with the presence of OM in persons with HIV infection initiating HAART who were followed for 2 years in Alabama. Contemporary profile of oral manifestations of HIV/AIDS and associated risk factors in a Southeastern US Clinic 8.9 Retrospective review of electronically captured data from patients initiating HAART at a Southeastern US clinic. Prevalence was determined and risk factors for overall OM, oropharyngeal candidiasis (OPC), and all other OM were evaluated using logistic regression. 1.Reif S, Geonnotti K, Whetten K. HIV infection and AIDS in the Deep South. Am J Public Health 2006;96(6):970-3. 2.Sawires S, Szekeres G, Coates T. Alabama and HIV/AIDS. Los Angeles: University of California; 2007. 3.HIV/AIDS in the South. 2010 [cited 2010 04 November]; Available from: http://www.aidsalabama.org/in-the-south.asphttp://www.aidsalabama.org/in-the-south.asp 4.Ledergerber B, Egger M, Erard V, Weber R, Hirschel B, Furrer H, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA 1999;282(23):2220-26. 5.Greenspan D, Canchola A, MacPhail L, Cheikh B, Greenspan J. Effect of highly active antiretroviral therapy on frequency of oral warts. The Lancet 2001;357(9266):1411-1412. 6.Mercante D, Leigh J, Lilly E, McNulty K, Fidel P. Assessment of the association between HIV viral load and CD4 cell count on the occurrence of oropharyngeal candidiasis in HIV-infected patients. J Acquir Immune Defic Syndr 2006;42(5):578-83. 7.Marcus M, Maida C, Freed J, Younai F, Coulter I, Der-Martirosian C, et al. Oral white patches in a national sample of medical HIV patients in the era of HAART. Community Dent Oral Epidemiol 2005;33(2):99-106. 8.Chattopadhyay A, Caplan D, Slade G, Shugars D, Tien H, Patton L. Risk indicators for oral candidiasis and oral hairy leukoplakia in HIV-infected adults. Community Dent Oral Epidemiol 2005;33(1):35-44. 9.Patton L, McKaig R, Straus R, Rogers D, Eron J. Changing prevalence of oral manifestations of human immuno-deficiency virus in the era of protease therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:299-304. Clinical and socio-demographic factors stratified by presence or absence of oral manifestations(n=744)  OM were found in 36% of HIV patients entering care at the University of Alabama at Birmingham 1917 Clinic in the 2-year study period.  Low baseline CD4 count and high baseline viral load were significantly associated with OL and OPC.  History of tobacco and alcohol abuse were not significantly associated with OL.  Low baseline CD4 was the most important predictor for OL. Due to their prevalence, especially in those patients with low baseline CD4 counts, training in the detection and treatment of OM are important components to HIV care. The accessibility of the oral cavity and the clinical relevance of oral HIV lesions cannot be overlooked or underestimated. Also, additional studies, preferable prospective cohort studies, are needed to accurately estimate the prevalence of OM associated with HIV infection. HIV infected individuals reporting the occurrence of these OM should be monitored more closely with a team approach between primary care HIV providers and oral health professionals with a more aggressive diagnostic surveillance for these common conditions. Irene Tamí-Maury, DMD, DrPH, MSc 1 ; James Willig, MD, MPH 2 ; Sten Vermund, MD, PhD 3 ; Pauline Jolly, PhD, MPH 2 ; Inmaculada Aban, PhD, MS 2 ; Jeff Hill, DMD 2 ; Craig Wilson, MD 2 1.The University of Texas MD Anderson Cancer Center, Houston, TX. 2. University of Alabama at Birmingham, Birmingham, AL. 3. Vanderbilt University, Nashville, TN. Objective Methods CharacteristicsAll patients n (%) Without OL n (%) With OL n (%) p-value Insurance Status <0.05 Uninsured173 (23.3)109 (22.8)64 (24.1) Public302 (40.6)180 (37.7)122 (45.9) Private269 (36.2)189 (39.5)80 (30.1) Death during the Study Period No708 (95.2)463 (96.9)245 (92.1)<0.01 Yes36 (4.8)15 (3.1)21 (7.9) Mean Baseline CD4 (cell/ul)276 ± 264.3331 ± 259.8179 ± 244.3<0.01 Baseline CD4 (cell/ul) <50173 (23.9)65 (14.0)108 (41.5)<0.01 50 to 199170 (23.4)101 (21.7)69 (26.5) 200 to 349151 (20.8)112 (24.1)39 (15.0) ≥ 350231 (31.9)187 (40.2)44 (16.9) Mean Baseline Viral Load (log 10 )4.2 ± 1.364.0 ± 1.344.6 ± 1.30<0.01 Baseline Viral Load <0.01 0-999 copies/mL142 (21.2)110 (25.2)32 (13.7) 1,000-9,999 copies/mL92 (13.7)73 (16.7)19 (8.2) 10,000-49,999 copies/mL132 (19.7)100 (22.9)32 (13.7) 50,000-99,999 copies/mL99 (14.8)62 (14.2)37 (15.9) ≥100,000205 (30.6)92 (21.1)113 (48.5) Total number of patients744 (100.0)478 (64.2)266 (35.8) Results Bivariate analysesMultivariate analyses PredictorsCrude OR 2 Adj OR 2 95% CI 3 p-value Baseline CD4 (cell/ul) <507.046.09 4 3.82-9.69<0.01 50 to 1992.872.591.63-4.11<0.01 200 to 3491.461.410.85-2.320.18 ≥ 350 (ref)1.00 Clinical and socio-demographic determinants of “Oral Lesions” 1 in the HIV Cohort 1 MODEL: OL vs. No-OL 2 Odd ratios, significant association (p<0.05) 3 Confidence Interval 4 p-trend 0.01 Bivariate analysesMultivariate analyses PredictorsCrude OR 2 Adj OR 2 95% CI 3 p-value Baseline CD4 (cell/ul) <509.378.19 4 4.92-13.66<0.01 50 to 1993.803.452.07-5.73<0.01 200 to 3491.581.520.86-2.690.15 ≥ 350 (ref)1.00 1 MODEL: OPC vs. No-OL 2 Odd ratios, significant association (p<0.05) 3 Confidence Interval 4 p-trend 0.01 Clinical and socio-demographic determinants of “Oro-pharyngeal Candidiasis” 1 in the HIV Cohort Results (cont.) Conclusions Implications for Practice References This study has been published by the Journal of Public Health Dentistry. For more information contact Dr. Tamí-Maury at irene.tami@fulbrightmail.org