Background: Orofacial pathologies such as oral candidiasis and melanotic hyperpigmentation are associated with HIV and are often more prevalent among those with advanced disease. This study aimed to assess the patterns of HIV-related orofacial pathologies and their associations with immune suppression among adults newly diagnosed with HIV in Nigeria. Methods: This cross-sectional study included newly diagnosed adult (>16 years) persons living with HIV (PWH) attending the HIV Care and Treatment Center at two leading tertiary referral hospitals in Ibadan (Southwest Nigeria). The study period ranged from April 2022 to February 2023. Oral examination was conducted by an oral medicine specialist and data on demographics and CD4+ T-cell counts/mm3 were collected. Descriptive statistics were used to describe the spectrum of orofacial pathologies among the study participants. Demographic and laboratory characteristics were compared between participants with and without orofacial pathologies using chi-square test. Data analysis was performed using SPSS (v25). Results: A total of 158 participants were recruited [males (40, 25.3%), females (118, 74.7%); mean age (standard deviation, SD) 39.5 (±11.9) years]. Over two-thirds (66.5%) of the participants had orofacial pathologies including candidiasis (37.3%), oral melanotic hyperpigmentation [OMH] (14.6%), combined candidiasis and OMH (11.4%). Other pathologies (3.2%) included herpes zoster, aphthous ulcer, necrotizing stomatitis, facial pruritic papular eruptions and Kaposi sarcoma. The proportion of participants with CD4 ≤ 200 cells/mm3 was significantly higher among those with orofacial pathologies (53, 74.6%) compared with those without (18, 25.4%) (p < 0.01). Across the orofacial pathology groups, the proportion of participants with CD4 ≤ 200 versus CD4 ≥ 200 was significantly greater among those with OMH (72.2%, 27.8%) than among those with candidiasis and OMH (64.3%, 35.7%) (p = 0.03). Conclusion: This study revealed a significant association between severe immunosuppression and HIV-related orofacial pathologies, particularly among those with OMH. Oro-facial pathologies are important markers of HIV disease severity in this population.
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