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Nkuna T, Maharaj S, Hari K. Benign Lymphoepithelial Cyst of Parotid Glands in HIV Infected Patients on Anti-Retroviral Therapy: A Narrative Review. Indian J Otolaryngol Head Neck Surg 2023; 75:547-556. [PMID: 37274976 PMCID: PMC10235290 DOI: 10.1007/s12070-022-03372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Human immunodeficiency virus-associated salivary gland disease is a complication seen in patients infected with the human immunodeficiency virus (HIV), with the commonest manifestation being the benign lymphoepithelial cyst (BLEC). The purpose of this study was to systematically review the effects of antiretroviral therapy (ART) in Human Immune Virus-infected patients with confirmed benign lymphoepithelial cysts of the parotid gland. The review was conducted between August 2020 and December 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Patients infected with a diagnosis of BLEC of parotid gland based were included. Studies from all countries were included with no age, language, and time restrictions. We used Microsoft Excel to create a data extraction form piloted before the official start. Inter-rater agreement was calculated for most of the data collection. The risk of bias was assessed using a Cochrane tool. After reviewing 512 records, 42 met the study criteria with a total of 785 patients. The median sample size of all eligible studies was 10 ranging from 2 to 60. The pooled mean age was 29 years ± 24.2. Studies primarily assessed the effect of ART on BLECs. Patients examined in the studies ranged from children to the elderly. Studies from South Africa had a higher proportion of women while American studies had a higher proportion of men. There is evidence that ARVs are effective in treating BLEC and may be used as first-line therapy for HIV infected patients.
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Affiliation(s)
- Tsakani Nkuna
- Charlotte Maxeke Johannesburg Academic Hospital, School of Clinical Medicine, Department of Otolaryngology, University of the Witwatersrand, Johannesburg, South Africa
| | - Shivesh Maharaj
- Charlotte Maxeke Johannesburg Academic Hospital, School of Clinical Medicine, Department of Otolaryngology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kapila Hari
- Charlotte Maxeke Johannesburg Academic Hospital, School of Clinical Medicine, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Roberto de Souza Fonseca R, Valois Laurentino R, Fernando Almeida Machado L, Eduardo Vieira da Silva Gomes C, Oliveira de Alencar Menezes T, Faciola Pessoa O, Branco Oliveira-Filho A, Resque Beckmann Carvalho T, Gabriela Faciola Pessoa de Oliveira P, Brito Tanaka E, Sá Elias Nogueira J, Magno Guimarães D, Newton Carneiro M, Mendes Acatauassú Carneiro P, Ferreira Celestino Junior A, de Almeida Rodrigues P, Augusto Fernandes de Menezes S. HIV Infection and Oral Manifestations: An Update. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Human immunodeficiency virus (HIV) causes a complete depletion of the immune system; it has been a major health issue around the world since the 1980s, and due to the reduction of CD4+ T lymphocytes levels, it can trigger various opportunistic infections. Oral lesions are usually accurate indicators of immunosuppression because these oral manifestations may occur as a result of the compromised immune system caused by HIV infection; therefore, oral lesions might be initial and common clinical features in people living with HIV. So, it is necessary to evaluate and understand the mechanism, prevalence, and risk factors of oral lesions to avoid the increase morbidity among those with oral diseases.
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Santos ALS, Braga-Silva LA, Gonçalves DS, Ramos LS, Oliveira SSC, Souza LOP, Oliveira VS, Lins RD, Pinto MR, Muñoz JE, Taborda CP, Branquinha MH. Repositioning Lopinavir, an HIV Protease Inhibitor, as a Promising Antifungal Drug: Lessons Learned from Candida albicans-In Silico, In Vitro and In Vivo Approaches. J Fungi (Basel) 2021; 7:jof7060424. [PMID: 34071195 PMCID: PMC8229492 DOI: 10.3390/jof7060424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022] Open
Abstract
The repurposing strategy was applied herein to evaluate the effects of lopinavir, an aspartic protease inhibitor currently used in the treatment of HIV-infected individuals, on the globally widespread opportunistic human fungal pathogen Candida albicans by using in silico, in vitro and in vivo approaches in order to decipher its targets on fungal cells and its antifungal mechanisms of action. Secreted aspartic proteases (Saps) are the obviously main target of lopinavir. To confirm this hypothesis, molecular docking assays revealed that lopinavir bound to the Sap2 catalytic site of C. albicans as well as inhibited the Sap hydrolytic activity in a typically dose-dependent manner. The inhibition of Saps culminated in the inability of C. albicans yeasts to assimilate the unique nitrogen source (albumin) available in the culture medium, culminating with fungal growth inhibition (IC50 = 39.8 µM). The antifungal action of lopinavir was corroborated by distinct microscopy analyses, which evidenced drastic and irreversible changes in the morphology that justified the fungal death. Furthermore, our results revealed that lopinavir was able to (i) arrest the yeasts-into-hyphae transformation, (ii) disturb the synthesis of neutral lipids, including ergosterol, (iii) modulate the surface-located molecules, such as Saps and mannose-, sialic acid- and N-acetylglucosamine-containing glycoconjugates, (iv) diminish the secretion of hydrolytic enzymes, such as Saps and esterase, (v) negatively influence the biofilm formation on polystyrene surface, (vi) block the in vitro adhesion to epithelial cells, (vii) contain the in vivo infection in both immunocompetent and immunosuppressed mice and (viii) reduce the Sap production by yeasts recovered from kidneys of infected animals. Conclusively, the exposed results highlight that lopinavir may be used as a promising repurposing drug against C. albicans infection as well as may be used as a lead compound for the development of novel antifungal drugs.
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Affiliation(s)
- André L. S. Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
- Programa de Pós-Graduação em Bioquímica (PPGBq), Instituto de Química (IQ), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-909, Brazil
- Correspondence: (A.L.S.S.); (M.H.B.); Tel.: +55-21-3938-0366 (A.L.S.S.)
| | - Lys A. Braga-Silva
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
- Programa de Pós-Graduação em Bioquímica (PPGBq), Instituto de Química (IQ), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-909, Brazil
| | - Diego S. Gonçalves
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
- Programa de Pós-Graduação em Bioquímica (PPGBq), Instituto de Química (IQ), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-909, Brazil
| | - Lívia S. Ramos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
| | - Simone S. C. Oliveira
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
| | - Lucieri O. P. Souza
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
| | - Vanessa S. Oliveira
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife 50740-465, Brazil; (V.S.O.); (R.D.L.)
| | - Roberto D. Lins
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife 50740-465, Brazil; (V.S.O.); (R.D.L.)
| | - Marcia R. Pinto
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense (UFF), Niterói 24210-130, Brazil;
| | - Julian E. Muñoz
- MICROS Group, Medicine Traslacional Institute, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia;
| | - Carlos P. Taborda
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo (USP), São Paulo 05508-060, Brazil;
- Laboratório de Micologia Médica—LIM53/IMTSP, Universidade de São Paulo (USP), São Paulo 05508-000, Brazil
| | - Marta H. Branquinha
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil; (L.A.B.-S.); (D.S.G.); (L.S.R.); (S.S.C.O.); (L.O.P.S.)
- Correspondence: (A.L.S.S.); (M.H.B.); Tel.: +55-21-3938-0366 (A.L.S.S.)
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Coulthard P, Tappuni AR, Ranauta A. Oral health and HIV: What dental students need to know. Oral Dis 2020; 26 Suppl 1:47-53. [PMID: 32862532 DOI: 10.1111/odi.13389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Dentists have an important role in reducing new HIV infections by early diagnosis and need to know how to treat patients with HIV and understand universal cross-infection control. In many parts of the world, healthcare professionals struggle to provide care because of barriers including stigma and cultural attitudes. AIM To investigate the effectiveness of a brief educational intervention in understanding/changing the views of dental school deans regarding the quality of the oral health and HIV/AIDS teaching and their willingness to undertake a curriculum review if appropriate. METHODS Questionnaires before and after interactive presentation to the deans of 30 Indonesian dental schools and discussion. RESULTS Only six of 30 dental school deans believed that their HIV undergraduate dental student teaching was inadequate before the intervention, but 29 of 30 deans recognised the need to review their curriculum after the intervention. Whilst the majority (24/30) felt that their HIV teaching was adequate, good or excellent, the majority also thought that their students would find it difficult to treat patients with HIV. CONCLUSION The brief educational intervention was effective in improving the understanding/changing the views of dental school deans regarding the quality of HIV/AIDS teaching and learning at their own institution and engaging a willingness to undertake curriculum review.
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Affiliation(s)
- Paul Coulthard
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anwar R Tappuni
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Amitha Ranauta
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Knight ET, Liu J, Seymour GJ, Faggion CM, Cullinan MP. Risk factors that may modify the innate and adaptive immune responses in periodontal diseases. Periodontol 2000 2016; 71:22-51. [DOI: 10.1111/prd.12110] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 12/31/2022]
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Batavia AS, Secours R, Espinosa P, Jean Juste MA, Severe P, Pape JW, Fitzgerald DW. Diagnosis of HIV-Associated Oral Lesions in Relation to Early versus Delayed Antiretroviral Therapy: Results from the CIPRA HT001 Trial. PLoS One 2016; 11:e0150656. [PMID: 26930571 PMCID: PMC4773149 DOI: 10.1371/journal.pone.0150656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/16/2016] [Indexed: 12/30/2022] Open
Abstract
Oral mucosal lesions that are associated with HIV infection can play an important role in guiding the decision to initiate antiretroviral therapy (ART). The incidence of these lesions relative to the timing of ART initiation has not been well characterized. A randomized controlled clinical trial was conducted at the GHESKIO Center in Port-au-Prince, Haiti between 2004 and 2009. 816 HIV-infected ART-naïve participants with CD4 T cell counts between 200 and 350 cells/mm3 were randomized to either immediate ART initiation (early group; N = 408), or initiation when CD4 T cell count was less than or equal 200 cells/mm3 or with the development of an AIDS-defining condition (delayed group; N = 408). Every 3 months, all participants underwent an oral examination. The incidence of oral lesions was 4.10 in the early group and 17.85 in the delayed group (p-value <0.01). In comparison to the early group, there was a significantly higher incidence of candidiasis, hairy leukoplakia, herpes labialis, and recurrent herpes simplex in the delayed group. The incidence of oral warts in delayed group was 0.97 before therapy and 4.27 post-ART initiation (p-value <0.01). In the delayed group the incidence of oral warts post-ART initiation was significantly higher than that seen in the early group (4.27 versus 1.09; p-value <0.01). The incidence of oral warts increased after ART was initiated, and relative to the early group there was a four-fold increase in oral warts if ART was initiated following an AIDS diagnosis. Based upon our findings, candidiasis, hairy leukoplakia, herpes labialis, and recurrent herpes simplex indicate immune suppression and the need to start ART. In contrast, oral warts are a sign of immune reconstitution following ART initiation.
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Affiliation(s)
- Ashita S. Batavia
- Weill Cornell Medical Center, New York, New York, United States of America
- * E-mail:
| | - Rode Secours
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Espinosa
- University of California San Francisco School of Dentistry, San Francisco, California, United States of America
| | - Marc Antoine Jean Juste
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Severe
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Jean William Pape
- Weill Cornell Medical Center, New York, New York, United States of America
- Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
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Mourad WF, Patel S, Young R, Khorsandi AS, Concert C, Shourbaji RA, Ciarrocca K, Bakst RL, Shasha D, Guha C, Garg MK, Hu KS, Kalnicki S, Harrison LB. Management algorithm for HIV-associated parotid lymphoepithelial cysts. Eur Arch Otorhinolaryngol 2016; 273:3355-62. [PMID: 26879995 DOI: 10.1007/s00405-016-3926-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.
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Affiliation(s)
- Waleed F Mourad
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA. .,Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA.
| | - Shyamal Patel
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA.,Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Rebekah Young
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Azita S Khorsandi
- Department of Radiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Catherine Concert
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Rania A Shourbaji
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Katherine Ciarrocca
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Daniel Shasha
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Kenneth S Hu
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Louis B Harrison
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
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Al-Shayyab MH, Abu-Hammad OA, Al-Omiri MK, Dar-Odeh NS. Antifungal prescribing pattern and attitude towards the treatment of oral candidiasis among dentists in Jordan. Int Dent J 2015; 65:216-26. [PMID: 26148537 DOI: 10.1111/idj.12173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM The aim of this study was to evaluate the attitude of Jordanian dentists towards the treatment of oral candidiasis and their current antifungal prescribing habits, shedding more light on the possible influence of their socio-professional factors on the pattern of prescribing and practice. METHODS A structured validated questionnaire was developed and tested; it was then emailed to a random sample of 600 Jordanian dental practitioners during the period of this cross-sectional survey. The questionnaire recorded practitioners' personal details and their attitude and prescribing of antifungal therapy for oral candidiasis. Statistical significance was based on probability values of <0.05 and was measured using the chi-square and Fisher's exact tests. Multiple logistic regression analysis was used to analyse the influence of respondents' socio-professional factors on their attitude towards oral candidiasis. RESULTS Of the 423 questionnaires returned, only 330 were included. The attitude of respondents was significantly influenced by their experience [odds ratio (OR) = 0.14; P < 0.001] and workplace (OR = 4.70; P < 0.001). Nystatin was the most commonly prescribed antifungal agent (78.2%), followed by miconazole (62.4%), which was prescribed for topical use. Systemic antifungals were prescribed by 21.2% of respondents, with a significant (P < 0.05) association with the country in which their qualification was obtained. CONCLUSION The attitude towards the treatment of oral candidiasis is much better among the least-experienced dentists working in private practice. Nystatin and miconazole are the most popular choices of antifungal agents among Jordanian dentists.
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Affiliation(s)
- Mohammad H Al-Shayyab
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Osama A Abu-Hammad
- Department of Prosthodontics, Faculty of Dentistry, Taibah University, Al Madina Al Monawara, Saudi Arabia
| | - Mahmoud K Al-Omiri
- Department of Prosthodontics, Faculty of Dentistry, The University of Jordan, Amman, Jordan
| | - Najla S Dar-Odeh
- Department of Oral Medicine, Faculty of Dentistry, Taibah University, Al Madina Al Monawara, Saudi Arabia
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Significant Depletion of CD4(+) T Cells Occurs in the Oral Mucosa during Simian Immunodeficiency Virus Infection with the Infected CD4(+) T Cell Reservoir Continuing to Persist in the Oral Mucosa during Antiretroviral Therapy. J Immunol Res 2015; 2015:673815. [PMID: 26065003 PMCID: PMC4430670 DOI: 10.1155/2015/673815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/07/2015] [Indexed: 11/18/2022] Open
Abstract
Human and simian immunodeficiency virus (HIV and SIV) infections are characterized by manifestation of numerous opportunistic infections and inflammatory conditions in the oral mucosa. The loss of CD4+ T cells that play a critical role in maintaining mucosal immunity likely contributes to this process. Here we show that CD4+ T cells constitute a minor population of T cells in the oral mucosa and display a predominantly central memory phenotype mirroring other mucosal sites such as the rectal mucosa. Chronic SIV infection was associated with a near total depletion of CD4+ T cells in the oral mucosa that appear to repopulate during antiretroviral therapy (ART). Repopulating CD4+ T cells harbored a large fraction of Th17 cells suggesting that ART potentially reconstitutes oral mucosal immunity. However, a minor fraction of repopulating CD4+ T cells harbored SIV DNA suggesting that the viral reservoir continues to persist in the oral mucosa during ART. Therapeutic approaches aimed at obtaining sustainable CD4+ T cell repopulation in combination with strategies that can eradicate the latent viral reservoir in the oral mucosa are essential for better oral health and long-term outcome in HIV infected patients.
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Jeffers-Francis LK, Burger-Calderon R, Webster-Cyriaque J. Effect of Leflunomide, Cidofovir and Ciprofloxacin on replication of BKPyV in a salivary gland in vitro culture system. Antiviral Res 2015; 118:46-55. [PMID: 25790744 DOI: 10.1016/j.antiviral.2015.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 12/16/2022]
Abstract
BK polyomavirus (BKPyV) is a known kidney tropic virus that has been detected at high levels in HIV-associated salivary gland disease (HIV-SGD), one of the most important AIDS associated oral lesions. BKPyV has been detected in HIV-SGD patient saliva and replicates in salivary gland cells in vitro. BKPyV antivirals are currently in wide use to guard against BKPyV mediated organ rejection in kidney transplant recipients. The goal of this study was to investigate the inhibitory effects of three such antiviral agents, Ciprofloxacin, Cidofovir, and Leflunomide in BKPyV infected salivary gland cells. Human salivary gland cells, and Vero cells, were infected with BKPyV, treated with antiviral drugs and assessed for BKPyV gene expression and viral replication for up to 5 days post infection. The kinetics of BKPyV replication were different in salivary gland cells compared to kidney cells. Ciprofloxacin and Cidofovir had minimal effect on metabolic activity and host cell DNA replication, however, cell toxicity was detected at the protein level with Leflunomide treatment. Ciprofloxacin decreased BKV T Ag and VP1 mRNA expression by at least 50% in both cell types, and decreased T Ag protein expression at days 3 and 4 post infection. A 2.5-4 log decrease in intracellular DNA replication and a 2-3 log decrease in progeny release were detected with Ciprofloxacin treatment. Cidofovir and Leflunomide also inhibited BKPyV gene expression and DNA replication. The three drugs diminished progeny release by 30-90% and 2- to 6-fold decreases in infectious virus were detected post drug treatment by fluorescence focus assay. Additionally, three clinical BKPyV isolates were assessed for their responses to these agents in vitro. Cidofovir and Leflunomide, but not Ciprofloxacin treatment resulted in statistically significant inhibition of BKPyV progeny release from salivary gland cells infected with HIVSGD BKPyV isolates. All three drugs decreased progeny release from cells infected with a transplant derived viral isolate. In conclusion, treatment of human salivary gland cells with each of the three drugs produced modest decreases in BKPyV genome replication. These data highlight the need for continued studies to discover more effective and less toxic drugs that inhibit BKPyV replication in salivary gland cells.
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Affiliation(s)
- Liesl K Jeffers-Francis
- Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, United States
| | - Raquel Burger-Calderon
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, United States
| | - Jennifer Webster-Cyriaque
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, United States; Department of Dental Research, School of Dentistry, University of North Carolina at Chapel Hill, United States; Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, United States.
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11
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Mourad WF, Hu KS, Shourbaji RA, Lin W, Harrison LB. Radiation therapy for benign lymphoepithelial cysts of parotid glands in HIV patients. Laryngoscope 2013; 123:1184-9. [DOI: 10.1002/lary.23878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Waleed F. Mourad
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Kenneth S. Hu
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Rania A. Shourbaji
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Wilson Lin
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Louis B. Harrison
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
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Mwangosi IE, Tillya J. Oral lesions associated with HIV/AIDS in HIV-seropositive patients attending a counselling and treatment centre in Dar es Salaam. Int Dent J 2012; 62:197-202. [DOI: 10.1111/j.1875-595x.2011.00108.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Feller L, Khammissa RA, Wood NH, Meyerov R, Pantanowitz L, Lemmer J. Oral ulcers and necrotizing gingivitis in relation to HIV-associated neutropenia: a review and an illustrative case. AIDS Res Hum Retroviruses 2012; 28:346-51. [PMID: 21728927 DOI: 10.1089/aid.2011.0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An unusual case of necrotizing gingivitis and neutropenic oral ulcers in an HIV-seropositive patient is presented. In spite of a very low CD4(+) T cell count and severe neutropenia, the necrotizing gingivitis responded favorably to standard periodontal treatment, and the oral ulcers healed after administration of granulocyte colony-stimulating factor (G-CSF). Nonspecific oral ulcers in HIV-seropositive subjects with neutropenia should be regarded as neutropenic ulcers. The term nonspecific ulcers should be restricted to those ulcers with nonspecific histopathological features in patients without neutropenia or a nutritional deficiency such as iron, folic acid, and vitamin B.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Razia A.G. Khammissa
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Neil H. Wood
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Robin Meyerov
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Centre, Pittsburgh, Pennsylvania
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, University of Limpopo, Pretoria, South Africa
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Jeffers L, Webster-Cyriaque JY. Viruses and salivary gland disease (SGD): lessons from HIV SGD. Adv Dent Res 2011; 23:79-83. [PMID: 21441486 DOI: 10.1177/0022034510396882] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Viral infections are often associated with salivary gland pathology. Here we review the pathogenesis of HIV-associated salivary gland disease (HIV-SGD), a hallmark of diffuse infiltrative lymphocytosis syndrome. We investigate the presence and contributions of viral diseases to the pathogenesis of salivary gland diseases, particularly HIV-SGD. We have detected BK viral shedding in the saliva of HIV-SGD patients consistent with viral infection and replication, suggesting a role for oral transmission. For further investigation of BKV pathogenesis in salivary glands, an in vitro model of BKV infection is described. Submandibular (HSG) and parotid (HSY) gland salivary cell lines were capable of permissive BKV infection, as determined by BKV gene expression and replication. Analysis of these data collectively suggests the potential for a BKV oral route of transmission and salivary gland pathogenesis within HIV-SGD.
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Affiliation(s)
- L Jeffers
- School of Dentistry, Department of Dental Ecology, University of North Carolina at Chapel Hill, NC, USA.
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15
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Greaves WO, Wang SA. Selected topics on lymphoid lesions in the head and neck regions. Head Neck Pathol 2011; 5:41-50. [PMID: 21287407 PMCID: PMC3037466 DOI: 10.1007/s12105-011-0243-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 01/17/2011] [Indexed: 12/14/2022]
Abstract
Lymphoid tissue located in the head and neck region include multiple regional lymph node chains as well as mucosa associated lymphoid tissue of the conjunctiva, buccal and nasopharyngeal cavities (Waldeyer's ring), and thyroid and salivary glands. This region is a rich source of antigenic stimuli including infectious agents coming from the outside environment. Many reactive conditions that affect lymphoid tissue in this region may mimic neoplasia. In fact, distinguishing between benign and malignant lymphoid proliferations in the head and neck region is a relatively frequent diagnostic challenge and in many instances, this distinction is not straightforward. It therefore behooves the practicing pathologist to be able to recognize the benign lymphoproliferative disorders that affect this region so as to effectively guide the appropriate clinical management of such patients. Kimura disease, Epstein Barr lymphadenitis, HIV associated salivary gland disease and chronic sialadenitis are benign conditions that not infrequently affect lymphoid tissue in the head and neck region and that share certain overlapping features with malignant lymphoma. In this brief review, we discuss these conditions and highlight clinicopathological features that may help distinguish them from neoplastic lymphoproliferations that may share similar features.
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Affiliation(s)
- Wesley O. Greaves
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009 USA
| | - Sa A. Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Unit 72, 1515 Holcombe Boulevard, Houston, TX 77030-4009 USA
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16
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Cadmus SI, Okoje VN, Taiwo BO, van Soolingen D. Exposure of dentists to Mycobacterium tuberculosis, Ibadan, Nigeria. Emerg Infect Dis 2010; 16:1479-81. [PMID: 20735939 PMCID: PMC3294986 DOI: 10.3201/eid1609.100447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine the prevalence of Mycobacteriumtuberculosis infection among dental patients and to assess dentists’ risk for exposure, we conducted a study among dental patients at a large tertiary hospital in Nigeria, a country where tuberculosis is endemic. Ten (13%) of 78 sputum samples obtained were positive for M. tuberculosis.
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Affiliation(s)
- Simeon I Cadmus
- Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria.
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17
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Vieira TR, Péret ADCA, Péret Filho LA. Alterações periodontais associadas às doenças sistêmicas em crianças e adolescentes. REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000200017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: O objetivo deste estuo foi revisar na literatura a inter-relação entre condições sistêmicas e a ocorrência de doenças periodontais em crianças e adolescentes, destacando-se as manifestações periodontais frequentemente encontradas. FONTES DE DADOS: Artigos indexados nas bases de dados Medline, Lilacs e Bibliografia Brasileira em Odontologia, nos últimos 20 anos, além de referências clássicas. As palavraschave utilizadas foram: "doença periodontal", "periodontite", "doenças sistêmicas", "criança" e "adolescente". SÍNTESE DOS DADOS: Doenças sistêmicas como hipofosfatasia, histiocitose X, síndrome de Down, síndrome de Papillon-Lefèvre, síndrome de Ehlers-Danlos, síndrome de Chédiak-Higashi, leucemias, Aids e as deficiências quantitativas e qualitativas dos neutrófilos estão associadas ao aparecimento de alterações periodontais graves em crianças e adolescentes. Os estudos demonstraram a ocorrência de alteração periodontal na forma de periodontite em crianças e adolescentes com doenças sistêmicas, podendo levar à perda precoce de dentes. CONCLUSÕES: A ocorrência de alterações periodontais é observada em crianças e adolescentes com alterações sistêmicas, que manifestam desde inflamação gengival até formas mais destrutivas, como periodontites e perda precoce dos dentes.
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Abstract
The authors review the clinical presentation, diagnostic evaluation, and treatment modalities for salivary gland enlargement in an HIV-infected population. Because this can occasionally be the presenting clinical symptom of HIV infection, it is important for the oral/maxillofacial surgeon to diagnose and manage HIV salivary gland enlargement.
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Affiliation(s)
- Rabie M Shanti
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, 110 Bergen Street, Newark, NJ 07103, USA
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Rare post-tonsillectomy complication in human immunodeficiency virus positive patient: ulcero-necrotic lesion of tonsillar fossa. The Journal of Laryngology & Otology 2008; 123:801-3. [PMID: 18702844 DOI: 10.1017/s0022215108003344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Post-tonsillectomy complications are common. The majority are easily recognised because of their frequent occurrence and can be managed as required. Infrequent complications may be misdiagnosed or managed inappropriately. We present a previously unreported complication of tonsillectomy. CASE REPORT A 45-year-old Afro-Caribbean man underwent routine tonsillectomy. Eight weeks post-operatively, he developed an ulcero-necrotic lesion of the tonsillar fossa. Subsequent investigation revealed that he was human immunodeficiency virus positive. It is highly likely that the patient's underlying immuno-compromised state, secondary to human immunodeficiency virus infection, contributed to this ulcero-necrotic lesion. CONCLUSIONS This case highlights the importance of clinician awareness of rare complications of tonsillectomy, in order to facilitate identification and appropriate investigation.
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Chattopadhyay A, Patton LL. Risk indicators for HIV-associated jointly occurring oral candidiasis and oral hairy leukoplakia. AIDS Patient Care STDS 2007; 21:825-32. [PMID: 18240892 DOI: 10.1089/apc.2007.0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Joint occurrence of two or more diseases may impact their transmission, clinical presentation, management approaches, and treatment efficacy. Although oral candidiasis (OC) and oral hairy leukoplakia (OHL) are the most commonly occurring opportunistic oral diseases of HIV-infected patients, literature describing their joint occurrence is sparse. The purpose of this project was to develop an explanatory multivariable model for joint occurrence of OC and OHL (OC-OHL). This cross-sectional study examined 631 adult dentate HIV-1 seropositive persons for OC and OHL from 1995-2000 at the University of North Carolina Hospitals in Chapel Hill, NC. Data collected from medical record review, interviews and clinical examinations were analyzed using chi(2) tests, t itests, and nonparametric tests. Multivariable proportional odds models were developed, using the likelihood ratio test and adjusting for several demographic, behavioral, and biological factors. Thirteen percent of participants had OC only; 12.8% had OHL only; 4.6% had OC-OHL; whereas 69.7% had neither. Occurrence of OC-OHL was independently associated with CD4+ counts less than 200 cells per microliter (adjusted odds ratio [OR] (95% confidence interval {CI}) = 13.4 (6.6, 27.2) and CD4+ counts 200-499 cells per microliter (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]). Combination antiretroviral therapy was protective (OR = 0.5 [0.3, 0.9]). In an HIV-1-infected population, lower CD4+ cell counts and smoking were important independent risk indicators for joint occurrence of OC and OHL.
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Affiliation(s)
- Amit Chattopadhyay
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Lauren L. Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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22
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Rationale to evaluate medically supervised safer smoking facilities for non-injection illicit drug users. Canadian Journal of Public Health 2005. [PMID: 16238151 DOI: 10.1007/bf03404029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Many cities are experiencing ongoing infectious disease epidemics and substantial community harm as a result of illicit drug use. In an effort to reduce these public order and public health concerns, consideration has been given to the opening in Vancouver of a safer smoking facility (SSF). The present review was conducted to examine if there is a rationale to support the evaluation of a SSF in the Canadian context. Available evidence suggests that conventional drug control strategies are insufficient to address the health and community harms of non-injection drug use, and that the public order benefits of supervised injection facilities may be relevant to SSFs. In addition, there is persuasive evidence to suggest there is potential for blood-borne disease transmission through the sharing of smoking paraphernalia, and the potential for SSFs to address this concern is a pressing public health question. Also relevant to this topic are interventions to prevent transition into injection drug use, and SSFs may also be evaluated as a potential strategy to address this concern.
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Abstract
The purpose of this review was to evaluate the evidence supporting the hypothesis that viral infection plays a role in the development of periodontitis. An involvement in periodontal diseases has been suspected specifically for human immunodeficiency virus (HIV) and herpes viruses. An association has been demonstrated between HIV infection and some distinct forms of periodontal infection, i.e. necrotizing lesions. Furthermore, reports of increased prevalence and severity of chronic periodontitis in HIV-positive subjects suggests that HIV infection predispose to chronic periodontitis. Several studies, most of them from the same research group, have demonstrated an association of herpesviruses with periodontal disease. Viral DNA have been detected in gingival tissue, gingival cervicular fluid (GCF) and subgingival plaque from periodontaly diseased sites. In addition markers of herpesviral activation have been demonstrated in the GCF from periodontal lesions. Active human cytomegalovirus (HCMV) replication in periodontal sites may suggest that HCMV re-activation triggers periodontal disease activity. Concerns regarding sampling, methods and interpretation cast doubts on the role of viruses as causes of periodontal disease.
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Affiliation(s)
- I Cappuyns
- School of Dental Medicine, University of Geneva, Geneva, Switzerland.
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Chattopadhyay A, Caplan DJ, Slade GD, Shugars DC, Tien HC, Patton LL. Risk indicators for oral candidiasis and oral hairy leukoplakia in HIV-infected adults. Community Dent Oral Epidemiol 2005; 33:35-44. [PMID: 15642045 DOI: 10.1111/j.1600-0528.2004.00194.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Oral candidiasis (OC) and oral hairy leukoplakia (OHL) are the most common oral mucosal diseases associated with HIV infection. Independent risk indicators associated with these sentinel opportunistic diseases have not been established in mixed race and gender adult populations in the southeast USA. The purposes of this study were 1) to estimate prevalence of OC and OHL among an HIV-1 positive adult population, and 2) to develop explanatory multivariable models for each disease outcome. METHODS This cross-sectional study evaluated 631 adult dentate HIV-1 seropositive persons examined for HIV-associated oral mucosal diseases between 1995 and 2000 at University of North Carolina Hospitals in Chapel Hill, North Carolina using data collected from medical record review, interview questionnaire and clinical examination. We analyzed the data using t-tests, anova, and unconditional logistic regression. RESULTS Prevalent OC was associated with low CD4+ cell count [<200 cells/microl, adj. OR = 12.7 (95%CI: 4.9-32.9)], antiretroviral combination therapy [OR = 0.6 (0.3-0.9)], and current smoking [OR = 2.5 (1.3-4.8)]. Prevalent OHL was associated with low CD4+ cell count [<200 cells/microl, OR = 7.2 (2.7-18.9)], antifungal medication use [OR = 1.8 (1.1-2.9)], current recreational drug use [OR = 2.5 (1.3-4.9)], and male gender [OR = 2.5 (1.3-4.8)]. CONCLUSIONS While CD4+ cell count, and antiretroviral medication were important risk indicators for OC, and OHL, cigarette smoking appears to be an important risk indicator for OC in HIV-1-infected populations.
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Chattopadhyay A, Caplan DJ, Slade GD, Shugars DC, Tien HC, Patton LL. Incidence of oral candidiasis and oral hairy leukoplakia in HIV-infected adults in North Carolina. ACTA ACUST UNITED AC 2005; 99:39-47. [PMID: 15599347 DOI: 10.1016/j.tripleo.2004.06.081] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To establish incidence rates and risk factors for HIV-associated oral candidiasis (OC), oral hairy leukoplakia (OHL), and any HIV-associated oral diseases (HIV-OD). DESIGN This prospective, cumulative case-control study followed 283 initially oral disease-free HIV-1-infected men and women for 2 years. Incidence rate ratios (IRR) and incidence proportions for OC, OHL, and HIV-OD were estimated. Multivariable analyses using Poisson regression determined the most parsimonious best-fitting model explaining the outcomes. RESULTS Incidence rate (per 1000 person-months) was 9.3 for OC, 6.8 for OHL, and 13.5 for HIV-OD. Incidence of OC was associated with low CD4 count (adjusted IRR = 3.0 (95% CI = 1.7, 5.1)), smoking (IRR = 1.9 (1.0, 3.8)) and combination antiretroviral therapy (IRR = 0.3 (0.1, 0.8)). Incidence of OHL was associated with low CD4 count, conditional upon smoking status. Conclusions Low CD4 count and smoking are important risk factors for HIV-associated OC and OHL. Antiretroviral medications are protective for OC but not for OHL.
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Affiliation(s)
- Amit Chattopadhyay
- Department of Informatics, School of Dentistry, Temple University, Philadelphia, PA, USA
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26
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Dunic I, Vesic S, Jevtovic DJ. Oral candidiasis and seborrheic dermatitis in HIV-infected patients on highly active antiretroviral therapy. HIV Med 2004; 5:50-4. [PMID: 14731170 DOI: 10.1111/j.1468-1293.2004.00185.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mucocutaneous manifestations such as oral candidiasis (OC) and seborrheic dermatitis (SD) are very common HIV-related opportunistic events and are usually initial markers of immunodeficiency. AIM The purpose of this study was to evaluate the efficacy of highly active antiretroviral therapy (HAART) in the regression of HIV-associated OC and SD. METHODS In a prospective study, 120 HIV-infected patients with OC and SD were divided into two groups: HAART-treated patients (group 1, n=76) and non-HAART-treated patients (group 2, n=44). Non-HAART-treated patients were given antimicrobial therapy. Study subjects were matched for sex, age, risk, and stage of HIV infection. The results were analysed by chi2 test and the Kaplan-Meier method. RESULTS At baseline, OC was evident in 59 (77.7%) of the HAART-treated patients and in 34 (77.3%) of the non-HAART-treated patients, while SD was present in 19 (25.0%) of the HAART-treated patients and in 17 (38.6%) of the non-HAART-treated patients. After a median follow-up period of 22 months, regression of OC and SD occurred in 49 (83.1%) and 16 (84.2%) of the HAART-treated patients, respectively. In the control group, regression of OC and SD occurred in only five (14.7%) and seven (41.2%) patients, respectively, during the same period. CONCLUSIONS HAART showed greater efficacy than standard antimicrobial therapy for the treatment of OC and SD in HIV-infected patients.
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Affiliation(s)
- I Dunic
- Institute of Dermatovenereology, Clinical Centre of Serbia, Belgrade, Serbia & Montenegro.
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Stanford TW, Rees TD. Acquired immune suppression and other risk factors/indicators for periodontal disease progression. Periodontol 2000 2003; 32:118-35. [PMID: 12756038 DOI: 10.1046/j.0906-6713.2003.03210.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Thomas W Stanford
- Department of Peiodontics Baylor College of Dentistry Texas A&M University System Health Science Center, Dallas, Texas, USA
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Abstract
Much has been learned about HIV disease during its first 20 years of existence in North America. The virus can now be successfully suppressed by HAART therapy, yet complete viral eradication from the body has not been demonstrated, and HIV transmissions continue to occur at an alarming rate. With support of the immune system, many HIV-infected patients will avoid oral and systemic opportunistic illnesses (or at least significantly prolong their time to onset). The number of HIV-infected patients under dental care is expected to increase in the future. Thus, dentists are fortunate that oral health care can be provided safely in the community setting for all but the very sickest of AIDS patients.
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Affiliation(s)
- Lauren L Patton
- Department of Dental Ecology, School of Dentistry, CB #7450, 388 Dental Office Building, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA.
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29
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Abstract
Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disorder found in men and women of all ages, races, and geographic regions. There are three forms of the lesions (minor, major, and herpetiform), with major aphthous ulcers causing significant pain and potential for scarring. In HIV-infected individuals, these ulcers occur more frequently, last longer, and produce more painful symptoms than in immunocompetent persons. In addition, they may be associated with similar ulcerations involving the esophagus, rectum, anus, and genitals. The diagnosis of HIV-induced RAS requires a careful history of the condition, and a thorough extra- and intra-oral examination. Oral mucosal biopsies are required for non-healing ulcers in order to exclude the possibility of deep fungal infections, viral infections, and neoplasms. The cause of the ulcers in HIV-positive persons has not been elucidated--local diseases, genetic, immunologic, and infectious factors all probably play a role. The goals of current treatments are to promote ulcer healing, to reduce ulcer duration and pain while maintaining nutritional intake, and to prevent or diminish the frequency of recurrence. Initial therapy for infrequent RAS recurrences includes over-the-counter topical protective and analgesic products. Initial therapy for frequent RAS outbreaks requires topical anesthetics, binding agents, and corticosteroids. Major RAS and non-healing minor or herpetiform RAS may require intralesional corticosteroids and systemic prednisone. Second-line immunomodulators for frequent and non-healing ulcers includes thalidomide and other immunomodulators.
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Affiliation(s)
- A Ross Kerr
- Department of Oral Medicine, New York University College of Dentistry, New York, New York 10010-4086, USA
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Musa NJ, Kumar V, Humphreys L, Aguirre A, Neiders ME. Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child. J Periodontol 2002; 73:657-63. [PMID: 12083540 DOI: 10.1902/jop.2002.73.6.657] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cicatricial pemphigoid (benign mucous membrane pemphigoid) is an autoimmune vesiculobullous disease that affects mucosal tissues of adults and rarely presents in children. Only 9 cases in the English literature have reported cicatricial pemphigoid in children, primarily as oral mucosal lesions. This paper presents a case of childhood cicatricial pemphigoid that clinically manifested as necrotizing ulcerative gingivitis (NUG). METHODS A 9-year-old girl presented with gingival bleeding and discomfort for 2 weeks. NUG was suspected and the patient was treated with antibiotics and an oral hygiene regimen. When the condition did not improve after repeated treatment trials, routine hematoxylin and eosin (H&E) and direct immunofluorescence examinations were performed. RESULTS Microscopic examination of H&E stained sections showed a non-specific ulceration with chronic inflammation. Direct immunofluorescence studies of peri-lesional tissue showed linear deposition of C3 at the basement membrane zone that was consistent with a diagnosis of cicatricial pemphigoid. CONCLUSION Cicatricial pemphigoid is an autoimmune ulcerative condition that is rarely seen in children. Immunofluorescence studies are essential to differentiate this condition from other ulcerative oral lesions.
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Affiliation(s)
- Nour J Musa
- Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, NY 14214, USA.
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