RELATIONSHIP BETWEEN ORAL MELANOTIC HYPERPIGMENTATION AND SERUM INFLAMMATORY CYTOKINES IN HIV SEROPOSITIVE PATIENTS—A CASE CONTROL STUDY

Background Oral melanotic hyperpigmentation in patients with HIV (HIV-OMH) has been attributed to the use of antifungal agents or antiretroviral drugs; alternatively, HIV-induced cytokine dysregulation causing activation of melanogenesis pathway has been well documented. Objective To assess the level of cytokine dysregulation as a possible biological etiologic factor for oral melanotic hyperpigmentation in patients newly diagnosed with HIV. Methods A case-control study conducted among newly diagnosed HIV seropositive patients yet to commence highly active antiretroviral therapy. Cases were patients with HIV with OMH, and the control group included age- and sex-matched patients with HIV without OMH. Clinical features and laboratory analysis of CD4 count and cytokine levels (IL-6 and tumor necrosis factor alpha) were compared between the OMH and non-OMH groups. Results Participants’ ages ranged from 22 to 68 years, with a mean of 42.4 ± 10.7 years. The tongue 34 was the most commonly affected site (75.5%), and multiple-site involvement was seen in 9 cases (25.7%). The mean rank value of tumor necrosis factor alpha was slightly higher among cases (36.24 pg/mL) compared to controls (34.76 pg/mL). On the other hand, the mean rank value of IL-6 was lower among cases (33.93 pg/mL) compared to controls (37.07 pg/mL). Thirty-three cases (94.3%) and 23 controls (65.7%) had CD4 count ≤350 cells/mm3 (P = .003). Conclusions There was no statistically significant difference in the serum cytokine levels of those with HIV-OMH and those without it. There was a statistically significant relationship between HIV-OMH and severe immunosuppression.