Objectives: To determine the frequency, distribution and histological diagnosis of oral lesions in relation to HIV infection at Muhimbili National Hospital, Tanzania. Methods: The study included 1302 patients attending Surgical Dental Clinic between 1998 and 2003 whom tissue biopsies were taken for histological diagnosis. Clinical information was collected from the files. Histological diagnosis was reviewed from freshly prepared paraffin embedded HE stained sections. HIV status was known in 113 cases of whom the screening was done using Enzygnotic anti-HIV-1 and 2 Plus ELISA and confirmed by Wellcozyme HIV-1 recombinant ELISA in all reactive sera. Only those specimens that were reactive in both assays were considered as HIV-1 sero-positive. Results: Fifty one (45.1%) patients among 113 cases tested for HIV were sero-positive. Thirty eight(97.7%) out of 39 cases diagnosed with oral Kaposi's sarcoma were seropositive, and surprisingly 34 (89.5%) among the HIV-positive were females. Of the twenty eight (28) cases diagnosed as having non-specific oral inflammatory conditions screened for HIV status, 9 (32.5%) were associated with HIV infection. Among the 21 cases oral squamos cell carcinoma with known HIV status, only one was HIV-positive. The 2 cases with non-Hodgkin's lymphoma screened for HIV were sero-negative. Conclusion: This study shows that almost all (97.4%) oral Kaposi's sarcoma and about one-third of chronic non-specific inflammation are associated with HIV infection at this Tanzanian National Hospital. The information may greatly contribute in the HIV-screening, diagnosis and management of such patients. Further studies are needed to explain why there is female preponderance in oral Kaposi's sarcoma associated with HIV syndrome.

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