| Among others, salivary factors such as secretory leukocyte protease inhibitor (salSLPI) may play an important role in human immunodeficiency virus (HIV) associated oral diseases (HIV-OD) such as oral Candidiasis (OC), and oral hairy leukoplakia (OHL). At present no published studies have evaluated independent risk factors/indicators of incident OC/OHL or HIV-OD; or their association with salSLPI. The purpose of this dissertation was (1) to estimate prevalence odds ratios (ORB), incidence density and rate ratios (IRR) for OC, OHL and HIV-OD; (2) to develop explanatory models for each; and (3) to study the association of salSLPI with OC, using history of OC as a surrogate.; Prevalent OC was associated with low CD4 cell count [<200 cells/μL - adj OR = 12.7 (95%CI: 4.9, 32.9)], antiretroviral combination therapy [OR = 0.4 (0.2, 0.8)], and current smoking [OR = 2.5 (1.3, 4.8)]. Prevalent OHL was associated with low CD4 cell count [<200 cells/μL - OR = 6.8 (2.6, 17.9)], Antifungal drug use [OR = 1.8 (1.1, 2.9)], current drug use [OR = 2.5 (1.3, 4.9)], and men [OR = 2.5 (1.3, 4.8)]. Joint occurrence of OC and OHL was associated with low CD4 cell count [OR = 13.4, (6.6, 27.2)], antiretroviral combination therapy [OR = 0.5 (0.4, 0.9)], current smoking [OR = 2.3 (1.4, 3.8)] and black ethnic/racial group [OR = 0.6 (0.4, 0.9)].; Incidence rate was 9.305 per 1000 person months for OC, 6.763 per 1000 person months for OHL, and 13.547 per 1000 person months for HIV-OD. Incident OC was associated with low CD4 cell count [adj IRR = 2.5 (1.5, 4.3)], current smoking [IRR = 1.9 (1.0, 3.8)] and combination antiretroviral therapy [IRR = 0.4 (0.2, 0.7)]. Incident OHL was associated with low CD4 cell count, conditional upon smoking status.; Sal SLPI levels were associated with history of OC conditional upon CD4 cell count. Sal SLPI cut-point at 2.1 μg/mL was useful in dichotomizing salSLPI levels into high and low. History of OC was associated with anti retroviral monotherapy [adj OR = 0.13 (0.03, 0.72)], current smoking [OR = 4.62 (1.05, 20.4)], and with salSLPI levels, conditional upon CD4 cell count.; These results served to define explanatory models for prevalent and incident OC, OHL and HIV-OD, and generate potential etiologic mechanisms based on association of salSLPI level and history of OC. |
