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The Q and your response on the PubMed articel on cortisol and geographic tongue
Jun 5, 2004

Dr. Pierone:

I am a bit confused by a Q to you (which consisted of an extensive PubMed quote)and your answer.

Basically, the quote suggested high cortisol levels for HIV infected people as well as chronic geographic tongue. You seemed to validate both aspects.

Yet, elsewhere on it is stated repeatedly that geographic tongue has no connection to HIV (forum on oral manfistations of HIV and even Dr. Young on this forum having said he knew of no connection). Same applies to cortisol - that HIV does not cause high cortisol and elsewhere that high cortisol is not more present in HIV positives versus negatives.

So, I am confused! Johns Hopkins does state that they find more geographic tongue among HIV positives than other patients and some HIV experts say that high cortisol does come with HIV infection until late stage when the adrenals are compromised.

Can you please shed light on this? Does HIV cause higher rates of geographic tongue and elevated cortisol...have you seen this in your practise and elsewhere?

Many thanks.

Response from Dr. Pierone

Sorry if the previous answer was confusing. I was responding to a question from someone with HIV infection that had high cortisol levels measured by his endocrinologist. I was speculating about whether high cortisol was a bad thing or good thing for someone with HIV and did not mean to imply that abnormal cortisol levels are commonly seen in HIV.

With regard to geographic tongue, it is an uncommon condition (and I have looked at a lot of HIV infected patient tongues over the years). It is notoriously difficult to assess the prevalence of rare conditions because one needs such a large sample size to begin with. So let's say we have some spare time and decide to study 10,000 people with HIV infection to determine the rate of geographic tongue. This is tough for one person to do, so we need a team. What is geographic tongue to one examiner is thought to be furrowed tongue by another, and coated tongue by some one else Don't snicker, but I had a patient enrolled in a clinical trial that had these 3 different diagnosis made by different members of our team and his tongue was no different all along. The point is that we don't know the true incidence of geographic tongue in people with HIV infection. My personal impression though is that it does occur more frequently in people with HIV, but it is still quite rare.

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