Oral Manifestations Among People Living with HIV in Eastern Saudi Arabia: A Cross-Sectional Cohort Study

Background: Oral manifestations are common among people living with HIV (PLWH) and serve as important clinical indicators of immune status and disease progression. Despite extensive global research, data from the Gulf Cooperation Council region, particularly Saudi Arabia, remain limited. Aims: In this study, we aimed to determine the prevalence of oral manifestations, and their associations with immunological parameters, in a large cohort of PLWH in the Eastern Province of Saudi Arabia. Methods: In this cross-sectional study, we enrolled 1500 adult PLWH who attended the Dammam Medical Complex HIV Clinic between January and December 2023. Demographic, clinical, and laboratory data were collected through medical record review. Standardized oral examinations were performed once per participant by two calibrated dentists using World Health Organization criteria. Statistical analyses included descriptive statistics, chi-square tests, and independent t-tests, with significance set at p < 0.05. Results: The cohort had a mean age of 38.3 ± 11.5 years and was predominantly male (78.3%). Most patients (89.6%) were receiving antiretroviral therapy (ART), with 75.7% achieving viral suppression. The mean CD4 count was 527 ± 221 cells/μL. Common co-infections included hepatitis C virus (11.7%), tuberculosis (17.2%), and hepatitis B virus (4.3%). The prevalence of any HIV-related oral manifestation was 72.9% (n = 1093); the most common findings were xerostomia (subjective dry mouth sensation, 48.1%), oral candidiasis (21.6%), and periodontitis (42.7%). Among severely immunosuppressed patients (CD4 < 200 cells/μL, n = 114), 89.5% had oral manifestations, with oral candidiasis affecting 66.7%. Severe immunosuppression was strongly associated with ART-naive status (92.0% vs. 8.0%, χ2 = 864.55, p < 0.001). The presence of HIV-related oral manifestations was significantly associated with CD4 count < 200 cells/μL (χ2 = 15.96, p < 0.001). Conclusions: HIV-related oral manifestations remain highly prevalent in our large Saudi cohort, despite high ART coverage, with xerostomia and oral candidiasis as the predominant findings. Severe immunosuppression was strongly associated with both ART-naive status and opportunistic oral infections. The association between oral manifestations and immunosuppression underscores their continued clinical relevance as accessible indicators of disease status. Integration of routine oral health screening into HIV care is essential for comprehensive patient management in the region.