G. Anaya-Saavedra | Universidad Autónoma Metropolitana-Xochimilco (original) (raw)

Papers by G. Anaya-Saavedra

Research paper thumbnail of Clinicopathological characterization of primary oral and sinonasal melanoma in a referral centre in Mexico City: 2000–2012

International Journal of Oral and Maxillofacial Surgery, 2014

In Mexico, there have been few studies on primary oral and sinonasal melanoma, an aggressive neop... more In Mexico, there have been few studies on primary oral and sinonasal melanoma, an aggressive neoplasm with a low survival rate and few therapeutic alternatives. Further, there is limited information about its clinical and histopathological characteristics. The aim of this retrospective study was to describe the clinicopathological profile of these tumours in patients attending a major oncology reference centre in Mexico City over a 12-year period. Demographic and clinical data were obtained from the clinical charts, and histopathological features were evaluated. x 2 , Fisher's exact, and Mann-Whitney U-tests were used for analysis; significance was set at P < 0.05. Thirty-three cases were studied (73% sinonasal melanoma (SNM) and 27% oral melanoma (OM)); 58% were female and the median age was 66 (Q 1 -Q 3 55.5-75) years. Compared with OM patients, SNM patients had a shorter time to diagnosis (16.7 vs. 11.7 months, P = 0.022), were identified at earlier stages (33.3% vs. 58.3%, P = 0.010), and all presented symptoms (66.7% vs. 100%, P = 0.015). All samples showed vertical growth and 96.9% exhibited pleomorphism. A higher proportion of cases with pleomorphism developed metastases at follow-up than those without (60% vs. 12.5%, P = 0.026). The present study provides valuable information that could form the basis of future studies in the search for advanced therapy modalities.

Research paper thumbnail of P281 Prospective evaluation of oral mucositis in a cohort of patients with acute leukemia

Oral Oncology Supplement, 2007

Research paper thumbnail of Clinical Spectrum of Oral Secondary Syphilis in HIV-Infected Patients

Journal of Sexually Transmitted Diseases, 2013

Research paper thumbnail of Clinical, histological and immunohistochemical findings in oral Kaposi's sarcoma in a series of Mexican AIDS patients. Comparative study

Journal of Oral Pathology & Medicine, 2009

ABSTRACT The origin of spindle cells (SC) in oral Kaposi&#39;s sarcoma (OKS) is still an intr... more ABSTRACT The origin of spindle cells (SC) in oral Kaposi&#39;s sarcoma (OKS) is still an intriguing aspect. Thus the aim of the present study was to compare the clinical, histological and immunohistochemical characteristics of OKS and oral pyogenic granuloma (OPG), in order to contribute to the knowledge of the cells involved in Kaposi&#39;s sarcoma pathogenesis. In this retrospective, observational and comparative study, 39 OKS and 30 OPG cases were included. Immunohistochemical studies were performed for vimentin, alpha SMA, desmin, C-kit, CD34, D2-40 and LANA-1 [human herpesvirus-8(HHV-8)]. Statistical comparisons were done using the chi-square and Wilcoxon-Mann-Whitney rank sum tests. Fourteen (35.9%) OKS cases also affected the skin, and 83.8% involved the palate. All OKS and OPG were positive for vimentin and CD34. OKS samples were positive for alpha SMA, and 25.6% expressed C-kit. All OKS cases were positive for HHV-8, and the number of positive cells increased significantly from early / intermediate to late histological stage. D2-40 was expressed in the cellular component and vascular walls of all OKS cases, but it was negative in OPG. HHV-8 expression was increased in late histological stages of OKS lesions. The expression of D2-40 marker in the vascular walls and SC supports the view of a lymphatic differentiation in neoplastic cells of OKS. Desmin, alpha SMA, D2-40, C-kit and HHV-8 were the main markers differently expressed in OKS and OPG.

Research paper thumbnail of Human papillomavirus-16 DNA methylation patterns support a causal association of the virus with oral squamous cell carcinomas

International Journal of Cancer, 2007

Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This ... more Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This virus is also detected in about 20% of all head and neck squamous cell carcinomas. While there is strong evidence for a causal etiological role in the case of tonsillar carcinomas, causal association with malignant lesions of the oral cavity is not yet conclusive. Our previous investigations of HPV-16 DNA methylation in anogenital sites have identified hypermethylation of the L1 gene and part of the long control region in many malignant lesions, but rarely in asymptomatic infections and low-grade precancerous lesions. Here, we report hypermethylation of this diagnostically important segment of the viral DNA in 10 out of 12 HPV-16 positive oral carcinomas from Mexican patients. These data indicate epigenetic changes of HPV-16 in oral carcinomas similar to those in anogenital carcinomas, suggesting carcinogenic processes under the influence of HPV-16 in most if not all of these oral malignant lesions. ' 2007 Wiley-Liss, Inc.

Research paper thumbnail of P44 Trends in oral and oropharyngeal cancer mortality rates in mexico, 1979-2003

Oral Oncology Supplement, 2007

Research paper thumbnail of HPV oral lesions in HIV-infected patients: the impact of long-term HAART

Journal of Oral Pathology & Medicine, 2013

Research paper thumbnail of Lingual ulcer as the only sign of recurrent mycobacterial infection in an HIV/AIDS-infected patient

Medicina oral, patologia oral y cirugia bucal

The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a myco... more The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of ...

Research paper thumbnail of Ulcera lingual como signo único de infección recurrente por micobacteria en un paciente con VIH/SIDA

Medicina oral, patología oral y cirugía bucal

The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a myco... more The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen inthe HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición �Salvador Zubirán� in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months du...

Research paper thumbnail of High pRb/p16INK4a Expression in Oral and Oropharyngeal Cancer

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2015

Research paper thumbnail of Asociación de lesiones bucales con el estado serológico para el VIH

Salud Pública de México, 2002

salud pública de méxico / vol.44, no. 2, marzo-abril de 2002 Lesiones bucales y VIH ARTÍCULO ORIG... more salud pública de méxico / vol.44, no. 2, marzo-abril de 2002 Lesiones bucales y VIH ARTÍCULO ORIGINAL

Research paper thumbnail of Oral clinical markers and viral load in a prospective cohort of Mexican HIV-infected patients

Research paper thumbnail of Synchronous Kinetics of CD4 + Lymphocytes and Viral Load before the Onset of Oral Candidosis and Hairy Leukoplakia in a Cohort of Mexican HIV-Infected Patients

AIDS Research and Human Retroviruses, 2005

An observational, prospective, longitudinal cohort study was performed at the AIDS Clinic of a te... more An observational, prospective, longitudinal cohort study was performed at the AIDS Clinic of a tertiary care institution in Mexico City to determine the association of viral load (VL) and CD4 ؉ lymphocyte kinetics with the development of oral candidosis (OC) and hairy leukoplakia (HL). Participants were HIV-infected adult subjects, without a history of or current OC or HL, not receiving HAART. Oral examinations were performed at baseline and every month for evidence of OC or HL; CD4 ؉ and VL determinations were done at baseline, at 6-month intervals, when oral lesions were detected, and 2 months later. Affected subjects (OL group) by OC or HL had clinical intervals defined before (antecedent), during (concurrent), and after their development. In the nonaffected individuals (NA group), 6-month intervals were determined. Differences (changes) along the clinical and study intervals were calculated for CD4 ؉ and VL. The median study time was 178 (range: 31-924) days; 99 patients were included. The 2-year cumulative incidence of either oral lesion was 54% (49.5% for OC and 33.2% for HL). In the OL group (31 patients) a progressive and continuous decrease of CD4 ؉ was found in the antecedent interval followed by a significant increase in VL in the concurrent period. The NA group showed a significant fall in CD4 ؉ by semester 3, without a significant rise of VL in the following semester. The effect of CD4 ؉ remained significant in a multivariate analysis. This study has shown that the onset of OC and/or HL is heralded by the sequence of a sustained reduction of CD4 ؉ , followed by a sharp increase of VL. In the multivariate analysis, the decrease in CD4 ؉ lymphocytes appeared to be the predominant factor predicting the appearance of these oral lesions. Their potential use as markers of a recent change in the immunologic and virologic status of HIV-infected individuals is emphasized.

Research paper thumbnail of The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients

Medicine, 2003

In developing countries, the variations in the clinical spectrum of human immunodeficiency virus ... more In developing countries, the variations in the clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions over time, and the possible effects of antiretroviral therapy, have not been described. In this study we evaluate the clinical spectrum of oral lesions in a series of HIV-infected patients when first examined at the acquired immunodeficiency syndrome (AIDS) clinic of a tertiary care institution in Mexico City, Mexico, and the changes observed over 12 years.

Research paper thumbnail of P179 High risk HPV infection is associated with oral squamous cell carcinoma in Mexican patients: a case control study

Oral Oncology Supplement, 2007

Research paper thumbnail of P.5 HPV infection in individuals with and withoutoral squamous cell carcinoma in Mexico: Preliminary findings

Oral Oncology Supplement, 2005

Research paper thumbnail of O81 Methylation patterns of the long control region (LCR) of HPV-16 support a causal association of the virus with oral cancer

Oral Oncology Supplement, 2007

Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This ... more Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This virus is also detected in about 20% of all head and neck squamous cell carcinomas. While there is strong evidence for a causal etiological role in the case of tonsillar carcinomas, causal association with malignant lesions of the oral cavity is not yet conclusive. Our previous investigations of HPV-16 DNA methylation in anogenital sites have identified hypermethylation of the L1 gene and part of the long control region in many malignant lesions, but rarely in asymptomatic infections and low-grade precancerous lesions. Here, we report hypermethylation of this diagnostically important segment of the viral DNA in 10 out of 12 HPV-16 positive oral carcinomas from Mexican patients. These data indicate epigenetic changes of HPV-16 in oral carcinomas similar to those in anogenital carcinomas, suggesting carcinogenic processes under the influence of HPV-16 in most if not all of these oral malignant lesions. ' 2007 Wiley-Liss, Inc.

Research paper thumbnail of Prospective evaluation of oral mucositis in acute leukemia patients receiving chemotherapy

Supportive Care in Cancer, 2010

Research paper thumbnail of hMLH1 promoter methylation is an early event in oral cancer

Oral Oncology, 2011

Promoter methylation is believed to inactivate the expression of hMLH1. This process has been imp... more Promoter methylation is believed to inactivate the expression of hMLH1. This process has been implicated in the tumorigenesis of oral squamous cell carcinoma (OSCC). Thus, the aim of this study was to determine the profile of hMLH1 methylation and protein expression in OSCC. The matched case-control study included 50 OSCC cases and 200 controls, with a median of age 64 (Q 1 -Q 3 54-71) years. Protein expression was determined by immunohistochemical staining, and hMLH1 gene promoter methylation was analyzed by methylation-specific polymerase chain reaction (MSP). A conditional logistic regression model for risk factors was built for OSCC cases and matched controls. Promoter methylation of hMLH1 was detected in 38 (76%) OSCC cases, but in none of the control samples. Of the 38 OSCC samples with promoter methylation, 12 (32%) were negative for hMLH1 protein, and corresponded to early clinical stages (10 in stage II and 2 in stage I). All 12 unmethylated samples showed positive stain for hMLH1. Multiple logistic regression analysis showed an OR of 16.54 (IC 95%: 1.69-161.68, p = 0.016) for methylation of the hMLH1 gene and early stages of OSCC, adjusting by gender and tobacco use. This study showed a high frequency of hMLH1 promoter methylation that occurred in most of the early stage cases and in about half of the late stage cases. It is proposed that hMLH1 promoter methylation is an early event that is maintained during tumor progression.

Research paper thumbnail of Oral Lesions as Clinical Markers of Highly Active Antiretroviral Therapy Failure: A Nested Case-Control Study in Mexico City

Clinical Infectious Diseases, 2007

Clinical markers that may predict virological failure during highly active antiretroviral therapy... more Clinical markers that may predict virological failure during highly active antiretroviral therapy (HAART) have not been evaluated adequately. The aim of the present study was to evaluate the usefulness of human immunodeficiency virus (HIV)-related oral lesions as clinical predictors of virological failure in HIV-infected patients receiving HAART. A nested case-control study was conducted within a cohort of 1134 HIV-infected patients receiving HAART who attended the AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City during the period 1997-2005. Case patients were patients who, after achieving an undetectable viral load, had at least 1 viral load determination &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2000 copies/mL while receiving treatment. Control subjects were patients who, after achieving an undetectable viral load, continued to have undetectable viral loads during the follow-up period. There were 2-3 control subjects for each case patient, matched according to duration of follow-up. Oral examinations were blinded to viral loads and CD4+ lymphocyte counts. Analyses were performed with multivariate conditional logistic regression models, and associations were shown as odds ratios (ORs) with 95% confidence intervals (CI). Positive predictive values were calculated. The target cohort consisted of 431 HIV-infected individuals; 47 case patients and 132 control subjects underwent complete oral examinations and formed the basis of the analysis. At the visit at which an undetectable viral load was determined, case patients and control subjects showed a similar frequency of HIV-related oral lesions (21.3% vs. 17.4%) (OR, 1.39; 95% CI, 0.57-3.38; P=.47). At the visit at which virological failure was determined, case patients showed a higher risk for HIV-related oral lesions (OR, 14.5; 95% CI, 4.21-49.94; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) and oral candidosis (OR, 26.2; 95% CI, 3.34-205.9; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) than did control subjects. The positive predictive value of HIV-related oral lesions and oral candidosis to identify patients who experienced virological failure while receiving HAART was 80% and 83%, respectively. HIV-related oral lesions and, specifically, oral candidosis may be considered to be clinical markers of virological failure in HIV-infected patients receiving HAART.

Research paper thumbnail of Clinicopathological characterization of primary oral and sinonasal melanoma in a referral centre in Mexico City: 2000–2012

International Journal of Oral and Maxillofacial Surgery, 2014

In Mexico, there have been few studies on primary oral and sinonasal melanoma, an aggressive neop... more In Mexico, there have been few studies on primary oral and sinonasal melanoma, an aggressive neoplasm with a low survival rate and few therapeutic alternatives. Further, there is limited information about its clinical and histopathological characteristics. The aim of this retrospective study was to describe the clinicopathological profile of these tumours in patients attending a major oncology reference centre in Mexico City over a 12-year period. Demographic and clinical data were obtained from the clinical charts, and histopathological features were evaluated. x 2 , Fisher's exact, and Mann-Whitney U-tests were used for analysis; significance was set at P < 0.05. Thirty-three cases were studied (73% sinonasal melanoma (SNM) and 27% oral melanoma (OM)); 58% were female and the median age was 66 (Q 1 -Q 3 55.5-75) years. Compared with OM patients, SNM patients had a shorter time to diagnosis (16.7 vs. 11.7 months, P = 0.022), were identified at earlier stages (33.3% vs. 58.3%, P = 0.010), and all presented symptoms (66.7% vs. 100%, P = 0.015). All samples showed vertical growth and 96.9% exhibited pleomorphism. A higher proportion of cases with pleomorphism developed metastases at follow-up than those without (60% vs. 12.5%, P = 0.026). The present study provides valuable information that could form the basis of future studies in the search for advanced therapy modalities.

Research paper thumbnail of P281 Prospective evaluation of oral mucositis in a cohort of patients with acute leukemia

Oral Oncology Supplement, 2007

Research paper thumbnail of Clinical Spectrum of Oral Secondary Syphilis in HIV-Infected Patients

Journal of Sexually Transmitted Diseases, 2013

Research paper thumbnail of Clinical, histological and immunohistochemical findings in oral Kaposi's sarcoma in a series of Mexican AIDS patients. Comparative study

Journal of Oral Pathology & Medicine, 2009

ABSTRACT The origin of spindle cells (SC) in oral Kaposi&#39;s sarcoma (OKS) is still an intr... more ABSTRACT The origin of spindle cells (SC) in oral Kaposi&#39;s sarcoma (OKS) is still an intriguing aspect. Thus the aim of the present study was to compare the clinical, histological and immunohistochemical characteristics of OKS and oral pyogenic granuloma (OPG), in order to contribute to the knowledge of the cells involved in Kaposi&#39;s sarcoma pathogenesis. In this retrospective, observational and comparative study, 39 OKS and 30 OPG cases were included. Immunohistochemical studies were performed for vimentin, alpha SMA, desmin, C-kit, CD34, D2-40 and LANA-1 [human herpesvirus-8(HHV-8)]. Statistical comparisons were done using the chi-square and Wilcoxon-Mann-Whitney rank sum tests. Fourteen (35.9%) OKS cases also affected the skin, and 83.8% involved the palate. All OKS and OPG were positive for vimentin and CD34. OKS samples were positive for alpha SMA, and 25.6% expressed C-kit. All OKS cases were positive for HHV-8, and the number of positive cells increased significantly from early / intermediate to late histological stage. D2-40 was expressed in the cellular component and vascular walls of all OKS cases, but it was negative in OPG. HHV-8 expression was increased in late histological stages of OKS lesions. The expression of D2-40 marker in the vascular walls and SC supports the view of a lymphatic differentiation in neoplastic cells of OKS. Desmin, alpha SMA, D2-40, C-kit and HHV-8 were the main markers differently expressed in OKS and OPG.

Research paper thumbnail of Human papillomavirus-16 DNA methylation patterns support a causal association of the virus with oral squamous cell carcinomas

International Journal of Cancer, 2007

Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This ... more Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This virus is also detected in about 20% of all head and neck squamous cell carcinomas. While there is strong evidence for a causal etiological role in the case of tonsillar carcinomas, causal association with malignant lesions of the oral cavity is not yet conclusive. Our previous investigations of HPV-16 DNA methylation in anogenital sites have identified hypermethylation of the L1 gene and part of the long control region in many malignant lesions, but rarely in asymptomatic infections and low-grade precancerous lesions. Here, we report hypermethylation of this diagnostically important segment of the viral DNA in 10 out of 12 HPV-16 positive oral carcinomas from Mexican patients. These data indicate epigenetic changes of HPV-16 in oral carcinomas similar to those in anogenital carcinomas, suggesting carcinogenic processes under the influence of HPV-16 in most if not all of these oral malignant lesions. ' 2007 Wiley-Liss, Inc.

Research paper thumbnail of P44 Trends in oral and oropharyngeal cancer mortality rates in mexico, 1979-2003

Oral Oncology Supplement, 2007

Research paper thumbnail of HPV oral lesions in HIV-infected patients: the impact of long-term HAART

Journal of Oral Pathology & Medicine, 2013

Research paper thumbnail of Lingual ulcer as the only sign of recurrent mycobacterial infection in an HIV/AIDS-infected patient

Medicina oral, patologia oral y cirugia bucal

The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a myco... more The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of ...

Research paper thumbnail of Ulcera lingual como signo único de infección recurrente por micobacteria en un paciente con VIH/SIDA

Medicina oral, patología oral y cirugía bucal

The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a myco... more The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen inthe HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición �Salvador Zubirán� in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months du...

Research paper thumbnail of High pRb/p16INK4a Expression in Oral and Oropharyngeal Cancer

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2015

Research paper thumbnail of Asociación de lesiones bucales con el estado serológico para el VIH

Salud Pública de México, 2002

salud pública de méxico / vol.44, no. 2, marzo-abril de 2002 Lesiones bucales y VIH ARTÍCULO ORIG... more salud pública de méxico / vol.44, no. 2, marzo-abril de 2002 Lesiones bucales y VIH ARTÍCULO ORIGINAL

Research paper thumbnail of Oral clinical markers and viral load in a prospective cohort of Mexican HIV-infected patients

Research paper thumbnail of Synchronous Kinetics of CD4 + Lymphocytes and Viral Load before the Onset of Oral Candidosis and Hairy Leukoplakia in a Cohort of Mexican HIV-Infected Patients

AIDS Research and Human Retroviruses, 2005

An observational, prospective, longitudinal cohort study was performed at the AIDS Clinic of a te... more An observational, prospective, longitudinal cohort study was performed at the AIDS Clinic of a tertiary care institution in Mexico City to determine the association of viral load (VL) and CD4 ؉ lymphocyte kinetics with the development of oral candidosis (OC) and hairy leukoplakia (HL). Participants were HIV-infected adult subjects, without a history of or current OC or HL, not receiving HAART. Oral examinations were performed at baseline and every month for evidence of OC or HL; CD4 ؉ and VL determinations were done at baseline, at 6-month intervals, when oral lesions were detected, and 2 months later. Affected subjects (OL group) by OC or HL had clinical intervals defined before (antecedent), during (concurrent), and after their development. In the nonaffected individuals (NA group), 6-month intervals were determined. Differences (changes) along the clinical and study intervals were calculated for CD4 ؉ and VL. The median study time was 178 (range: 31-924) days; 99 patients were included. The 2-year cumulative incidence of either oral lesion was 54% (49.5% for OC and 33.2% for HL). In the OL group (31 patients) a progressive and continuous decrease of CD4 ؉ was found in the antecedent interval followed by a significant increase in VL in the concurrent period. The NA group showed a significant fall in CD4 ؉ by semester 3, without a significant rise of VL in the following semester. The effect of CD4 ؉ remained significant in a multivariate analysis. This study has shown that the onset of OC and/or HL is heralded by the sequence of a sustained reduction of CD4 ؉ , followed by a sharp increase of VL. In the multivariate analysis, the decrease in CD4 ؉ lymphocytes appeared to be the predominant factor predicting the appearance of these oral lesions. Their potential use as markers of a recent change in the immunologic and virologic status of HIV-infected individuals is emphasized.

Research paper thumbnail of The Changing Clinical Spectrum of Human Immunodeficiency Virus (HIV)-Related Oral Lesions in 1,000 Consecutive Patients

Medicine, 2003

In developing countries, the variations in the clinical spectrum of human immunodeficiency virus ... more In developing countries, the variations in the clinical spectrum of human immunodeficiency virus (HIV)-related oral lesions over time, and the possible effects of antiretroviral therapy, have not been described. In this study we evaluate the clinical spectrum of oral lesions in a series of HIV-infected patients when first examined at the acquired immunodeficiency syndrome (AIDS) clinic of a tertiary care institution in Mexico City, Mexico, and the changes observed over 12 years.

Research paper thumbnail of P179 High risk HPV infection is associated with oral squamous cell carcinoma in Mexican patients: a case control study

Oral Oncology Supplement, 2007

Research paper thumbnail of P.5 HPV infection in individuals with and withoutoral squamous cell carcinoma in Mexico: Preliminary findings

Oral Oncology Supplement, 2005

Research paper thumbnail of O81 Methylation patterns of the long control region (LCR) of HPV-16 support a causal association of the virus with oral cancer

Oral Oncology Supplement, 2007

Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This ... more Infection with human papillomavirus-16 (HPV-16) is the cause of most anogenital carcinomas. This virus is also detected in about 20% of all head and neck squamous cell carcinomas. While there is strong evidence for a causal etiological role in the case of tonsillar carcinomas, causal association with malignant lesions of the oral cavity is not yet conclusive. Our previous investigations of HPV-16 DNA methylation in anogenital sites have identified hypermethylation of the L1 gene and part of the long control region in many malignant lesions, but rarely in asymptomatic infections and low-grade precancerous lesions. Here, we report hypermethylation of this diagnostically important segment of the viral DNA in 10 out of 12 HPV-16 positive oral carcinomas from Mexican patients. These data indicate epigenetic changes of HPV-16 in oral carcinomas similar to those in anogenital carcinomas, suggesting carcinogenic processes under the influence of HPV-16 in most if not all of these oral malignant lesions. ' 2007 Wiley-Liss, Inc.

Research paper thumbnail of Prospective evaluation of oral mucositis in acute leukemia patients receiving chemotherapy

Supportive Care in Cancer, 2010

Research paper thumbnail of hMLH1 promoter methylation is an early event in oral cancer

Oral Oncology, 2011

Promoter methylation is believed to inactivate the expression of hMLH1. This process has been imp... more Promoter methylation is believed to inactivate the expression of hMLH1. This process has been implicated in the tumorigenesis of oral squamous cell carcinoma (OSCC). Thus, the aim of this study was to determine the profile of hMLH1 methylation and protein expression in OSCC. The matched case-control study included 50 OSCC cases and 200 controls, with a median of age 64 (Q 1 -Q 3 54-71) years. Protein expression was determined by immunohistochemical staining, and hMLH1 gene promoter methylation was analyzed by methylation-specific polymerase chain reaction (MSP). A conditional logistic regression model for risk factors was built for OSCC cases and matched controls. Promoter methylation of hMLH1 was detected in 38 (76%) OSCC cases, but in none of the control samples. Of the 38 OSCC samples with promoter methylation, 12 (32%) were negative for hMLH1 protein, and corresponded to early clinical stages (10 in stage II and 2 in stage I). All 12 unmethylated samples showed positive stain for hMLH1. Multiple logistic regression analysis showed an OR of 16.54 (IC 95%: 1.69-161.68, p = 0.016) for methylation of the hMLH1 gene and early stages of OSCC, adjusting by gender and tobacco use. This study showed a high frequency of hMLH1 promoter methylation that occurred in most of the early stage cases and in about half of the late stage cases. It is proposed that hMLH1 promoter methylation is an early event that is maintained during tumor progression.

Research paper thumbnail of Oral Lesions as Clinical Markers of Highly Active Antiretroviral Therapy Failure: A Nested Case-Control Study in Mexico City

Clinical Infectious Diseases, 2007

Clinical markers that may predict virological failure during highly active antiretroviral therapy... more Clinical markers that may predict virological failure during highly active antiretroviral therapy (HAART) have not been evaluated adequately. The aim of the present study was to evaluate the usefulness of human immunodeficiency virus (HIV)-related oral lesions as clinical predictors of virological failure in HIV-infected patients receiving HAART. A nested case-control study was conducted within a cohort of 1134 HIV-infected patients receiving HAART who attended the AIDS Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City during the period 1997-2005. Case patients were patients who, after achieving an undetectable viral load, had at least 1 viral load determination &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2000 copies/mL while receiving treatment. Control subjects were patients who, after achieving an undetectable viral load, continued to have undetectable viral loads during the follow-up period. There were 2-3 control subjects for each case patient, matched according to duration of follow-up. Oral examinations were blinded to viral loads and CD4+ lymphocyte counts. Analyses were performed with multivariate conditional logistic regression models, and associations were shown as odds ratios (ORs) with 95% confidence intervals (CI). Positive predictive values were calculated. The target cohort consisted of 431 HIV-infected individuals; 47 case patients and 132 control subjects underwent complete oral examinations and formed the basis of the analysis. At the visit at which an undetectable viral load was determined, case patients and control subjects showed a similar frequency of HIV-related oral lesions (21.3% vs. 17.4%) (OR, 1.39; 95% CI, 0.57-3.38; P=.47). At the visit at which virological failure was determined, case patients showed a higher risk for HIV-related oral lesions (OR, 14.5; 95% CI, 4.21-49.94; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) and oral candidosis (OR, 26.2; 95% CI, 3.34-205.9; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) than did control subjects. The positive predictive value of HIV-related oral lesions and oral candidosis to identify patients who experienced virological failure while receiving HAART was 80% and 83%, respectively. HIV-related oral lesions and, specifically, oral candidosis may be considered to be clinical markers of virological failure in HIV-infected patients receiving HAART.