Occurrence of oral candidiasis (OC) and oral hairy leukoplakia (OHL) singly or together in HIV-1 infected persons may reflect an impaired oral defense system. Literature describing joint occurrence of these diseases is sparse. Objective: To develop an explanatory multivariable model for joint occurrence of OC and OHL. Methods: This cross-sectional study evaluated 631 adult dentate HIV-1 seropositive persons (race: White/ Black only) examined for OC and OHL from 1995 - 2000 at the University of North Carolina Hospitals in Chapel Hill, NC. Data collected from medical record review, interview questionnaires and clinical examinations were analyzed using chi-sq tests, t-tests, and ANOVA. Multivariable proportional odds models were developed, employing likelihood ratio test, using those without OC or OHL as the outcome reference group. Independent variables included: age, race, sex, sexual orientation, smoking, recreational drug use, CD4 cell count, antiretroviral medication use, and antifungal medication use. Results: Thirteen percent of participants had OC only; 12.8% had OHL only; 4.6% had both OC and OHL; whereas 69.7% had neither. Higher odds for joint occurrence of OC and OHL were associated with CD4+ counts < 200 cells/ml [adj. OR (95%CI) = 13.4 (6.6, 27.2)] and CD4+ counts 200-499 cells/mL [OR= 3.9 (1.9, 8.1)]; current smokers [OR= 2.3 (1.4, 3.8)]; and Whites [OR= 1.7 (1.1, 2.5)]. Race was not a significant risk indicator for each condition separately. Combination antiretroviral therapy was protective [OR= 0.5 (0.3, 0.9)]. Conclusions: These data established independent risk indicators for joint occurrences of OC and OHL in an HIV-1 infected population. Lower CD4 cell count, smoking, and White race were important risk indicators for joint occurrence of OC and OHL. (Supported by NIH: DE11369, 5T32DE07191, and P30-HD27360)

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