Diagnostic oral biomarkers of immunosuppression in apparently healthy seropositive HIV population, in South Western Uganda

Abstract

Background: Accurate diagnosis remain key to effective intervention of endemic and pandemic diseases even up to the developed world. Despite availability of many high-quality diagnostic tests for immunosuppression in the developed countries, they are neither available, affordable nor accessible in rural communities of Africa. Clinical diagnostic surrogate biomarkers may be suitable alternative. Objective: To evaluate oral clinical manifestations as biomarkers of immunosuppression in apparently healthy population of Human Immunodeficiency Virus (HIV) infected patients in resource poor Masaka, Mbarara and Rukungiri districts, of South Western Uganda. Methods: Visual oral inspection of 304 apparently health and HIV seropositive patients attending the AIDS Support Organization clinics in study districts of Uganda was done to detect and establish oral biomarkers associated with immunosuppression in HIV disease. Standard methods were used to reconfirm the HIV sero-positivity status and clinical staging of oral manifestations of consenting clients. Result: Figures 1-22 shows representative 304 oral manifestations of research participants. Figures 1-5 depicts 140 (46.1%) pseudomembranous candidiasis. Figures (6-9) depicts representative photographs of 53 (17.4%) erythemathous candidiasis (Figures 7 & 8) and also 63 (20.7%) shows erythemathous candidiasis found co-infecting with pseudomembranouse candidiasis in (Figures 9 & 10). Figure 10 shows linear gingival erythemathouse banding. Figures 11-15 shows Karposi sarcoma developmental stages and Figure 16-18 shows 7 (2.3%) Angular cheilitis. Figure 19 shows 3 (1.0%) aphthous ulceration of anterior portion of the tongue. Figure 20 shows 1 (0.3%) Acute necrotizing ulcerative gingivitis (ANUG) while Figures 21 & 22 shows 10 (3.3%) intra-oral pigmentation. Conclusion: Visual oral inspection of apparently healthy HIV seropositive individuals revealed different oral manifestations that may serve as diagnostic oral biomarkers of immunosuppression in apparently healthy but HIV infected population in Uganda. Poor resources drive the need for available and affordable diagnostic tools for improved and effective intervention.