Oral manifestations and dental status in paediatric HIV infection

HAART medication and oral health status in children and adolescent HIV infected: A case control study

BACKGROUND

The advent of Highly Active Anti-Retroviral Therapy (HAART) does influence the overall oral health care of children. The children undergoing HAART have shown an increase in caries activity owing to sugars in medicines to make them more palatable.

AIM

The aim of the study was to assess and compare the Oral Health of Children Living with HIV/AIDS (CLHAs) and Adolescents Living with HIV/AIDS (ALHAs) undergoing HAART and those who are HAART-naïve.

METHODS

This study was carried out at different Non-Governmental Organizations (NGO's) across Kerala, India. The study group consisted of 150 HIV-infected children aged 6-18 years. They were divided into two groups. Group 1 comprised of children prior to onset of HAART and Group 2 included children who had been on HAART for more than 3 years (HAART naïve). The assessment of dental caries status and dental plaque status was done. The observations were tabulated and statistically analyzed.

RESULTS

On Statistical Analysis, significant difference was noted between the groups with the Group 1(2.26 ± 0.58;p value = .000*) showing higher scores of dental plaque and a significant difference was also observed with respect to dental caries scores with DMFT and dmft scores higher in Group 2(dmft 2.08 ± 2.85; p value = .001* and DMFT 4.10 ± 1.71;p value = .003*).

CONCLUSION

It was concluded that oral hygiene conditions were poor in children with HIV, with dental plaque scores more in HAART-naïve which may be due to their lesser visits and reinforcements regarding oral hygiene from a dentist and dental caries score more in HAART group, this may be attributed to the hidden sugars present in HAART medications to make it more palatable. Early recognition and management of oral conditions are important to improve the quality of life for these children.

A Review of Basic Knowledge of HIV Infection for Orthodontic Management of HIV Patients

Human immunodeficiency virus (HIV) is a retrovirus that causes an infection affecting immunity-providing white blood cells. The HIV pandemic is far from over and is a major socio-economical burden. As there is no cure yet, prevention of new infections is the major path to control the infection. There is a low chance of orthodontic procedures carrying a risk of HIV infection transmission. It is important to have knowledge about the disease to effectively and safely treat known or unknown patients with HIV.

Viruses of the oral cavity: Prevalence, pathobiology and association with oral diseases

The human oral cavity contains a plethora of habitats and tissue environments, such as teeth, tongue, and gingiva, which are home to a rich microbial flora including bacteria, fungi, and viruses. Given the exposed nature of the mouth, oral tissues constantly encounter infectious agents, forming a complex ecological community. In the past, the discussion of microbiological aspects of oral disease has traditionally focused on bacteria and fungi, but viruses are attracting increasing attention as pathogens in oral inflammatory diseases. Therefore, understanding viral prevalence, pathogenicity, and preference regarding oral tissues is critical to understanding the holistic effects of viruses on oral infections. Recent investigations have demonstrated the abundance of certain viruses in oral inflammatory diseases, suggesting an association between viruses and disease. Human herpesviruses are the most extensively studied viruses in different oral inflammatory diseases. However, challenges in viral detection and the lack of reproducible in vitro and in vivo infection models have limited our progress in understanding viruses and their contribution to oral diseases. This review presents a summary of major mammalian viruses and associated diseases in the human oral cavity. The emergence of a recent pathogen SARS-CoV-2 and its tropism for salivary and periodontal tissues further highlights the relevance of the oral cavity in host-pathogen interaction. Understanding how these different viruses present clinically and influence oral health will advance our understanding of multifactorial oral diseases and their association with viruses.

The Prevalence, Etiological Agents, Clinical Features, Treatment, and Diagnosis of HIV-Associated Oral Candidiasis in Pediatrics Across the World: A Systematic Review and Meta-Analysis

In HIV-infected pediatrics, oral candidiasis (OC) is a global issue of concern due to its association with dysphagia, malnutrition, and mortality. The present systematic review and meta-analysis are the first to determine the prevalence of OC in HIV-infected pediatrics worldwide. We searched international (PubMed, Web of Science, Scopus, and Embase) databases for studies published between January 2000 to May 2020 reporting the epidemiologic features of OC in HIV-infected pediatrics. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA guidelines. The results of the meta-analysis were visualized as a forest plot. Heterogeneity was also analyzed using the I ², and τ² statistics. The publication bias was evaluated using Egger test. The literature search revealed 1926 studies, of which 34 studies met the eligibility criteria, consisting of 4,474 HIV-infected pediatrics from 12 different countries. The overall prevalence of OC among HIV-infected pediatrics was 23.9% (95% CI 17.3-32.0%), and Candida albicans was the most prevalent etiologic agent. Pseudomembranous candidiasis was the predominant clinical manifestation in HIV-infected pediatrics suffering from OC. Thirty articles involving 4,051 individuals provided data on HIV treatment status. Among the 4,051 individuals, 468 (11.53%) did not receive HIV treatment. The data from 11 articles demonstrated that HIV treatment was significantly associated with a reduction in oral Candida colonization or infection. In contrast, others showed the opposite relationship or did not report any statistical data. A high level of I ² (I ² = 96%, P < 0.01) and τ² (τ² = 1.36, P < 0.01) was obtained among studies, which provides evidence of notable heterogeneity between studies. OC is approximately frequent in HIV-positive children. Therefore, efforts should be made to teach dental and non-dental clinicians who care for HIV-infected pediatrics to diagnose and treat this infection.

Dental development in a sample of South African HIV-positive children

AIMS

While oral soft tissue manifestations associated with HIV-infection in children are well documented, few studies have investigated the dental development of this group. The aim of this study was to assess dental development in a sample of HIV-positive children in comparison with an age-matched HIV-negative control group.

METHODS AND RESULTS

The sample comprised 44 HIV-positive children and 44 HIV-negative children matched for age, gender, and ethnicity. An orthopantomograph (OPG) of each patient was assessed in order to calculate the dental age. The mineralization stages of teeth were used to calculate the dental age using tables formulated by Phillips and van Wyk-Kotze for this grouping. Results showed that dental development for both groups were similar to the dental age-related tables. HIV-positive children between 8 and 10 years of age showed significantly advanced dental development (p = 0.04). HIV-positive females showed significant advancement in dental age as compared to their chronological ages. Thirty-six (81.8%) HIV-positive children were on antiretroviral (ARV) drugs.

CONCLUSION

HIV-positive children presented stages of dental development in accordance with their chronological ages and in tandem with that of the HIV-negative controls.

Delayed tooth emergence in children infected with human immunodeficiency virus

OBJECTIVE

There is limited evidence that early deficits in growth might be reflected in tooth emergence in children infected with human immunodeficiency virus (HIV). The purpose of this study was to prospectively evaluate tooth emergence timing between children positive and negative for HIV in the exposed and unexposed groups, respectively.

STUDY DESIGN

A longitudinal study of children positive for HIV and HIV-negative household peers, aged 2 to 15 years was conducted between 1993 and 1996. Emergence status was determined for the maxillary and the mandibular permanent first molars and the central and lateral incisors. A multivariable, discrete time, proportional hazards model was fitted to the data. Median age of emergence for each of the six pairs of teeth was calculated using the parameter estimates from the regression model.

RESULTS

A total of 116 participants (62 HIV positive, 54 HIV negative) completed six examinations over the 36-month study period. Statistical differences in tooth emergence timing were observed for five of the six tooth pairs, with children positive for HIV being less likely to have emergence of the corresponding tooth compared with the children negative for HIV. Age differences for each tooth pair ranged from 0.7 to 1.5 years, with a median emergence age difference of 1.03 years.

CONCLUSIONS

Delayed tooth emergence of the permanent dentition was observed in children with HIV.

Levels of salivary IgA antibodies to Candida spp. in HIV-infected adult patients: a systematic review

OBJECTIVE

To perform a systematic review of published data with the aim of evaluating the levels of IgA antibodies to Candida albicans in HIV-infected adult patients.

METHODS

The search strategy was based on PubMed, Web of Science, Google Scholar, Cochrane and EMBASE databases. Also, the reference lists of included studies were searched. All abstracts found by electronic searches were independently scrutinized by two reviewers. To be eligible for review, the controlled studies had to present the following characteristics: samples of both HIV-infected adults and noninfected adults; appropriate HIV-diagnostic tests for both patient groups (case and control); IgA-diagnostic test applied to a similar population sample.

RESULTS

Of 144 studies found, only six met the initial eligibility criteria, but three were excluded after a thorough analysis. To assess the methodological quality of the three remaining studies, they were categorized according the risk of bias. The three selected studies revealed that the levels of C. albicans-specific IgA antibody were higher in HIV-infected individuals compared with the control group.

CONCLUSION

Adequate IgA antibody responses to C. albicans appear to be maintained, since the levels of these antibodies were higher in all studies selected. Although the findings of this systematic review are encouraging, the scientific evidence should be interpreted carefully because there are only a few reports in the literature, mostly because of the lack of important methodological details or the varying methodologies employed.

Associations among the use of highly active antiretroviral therapy, oral candidiasis, oral Candida species and salivary immunoglobulin A in HIV-infected children

OBJECTIVES

The aim was to examine the impact of antiretroviral therapy on the prevalence of oral candidiasis, recovery of oral Candida spp. , and salivary levels of total secretory immunoglobulin A (SIgA) and Candida-specific SIgA in human immunodeficiency virus (HIV)-infected children.

STUDY DESIGN

Sixty-six HIV+ and 40 HIV- children were cross-sectionally examined for the presence of oral lesions. Whole stimulated saliva samples were collected for the identification of Candida spp. using culture and measurement of total and specific SIgA using enzyme-linked immunosorbent assay (ELISA).

RESULTS

The HIV+ children had a higher prevalence of oral candidiasis (P < .05), higher frequency of detection of Candida spp. (P < .05), and higher levels of total (P < .05) and Candida-specific SIgA (P < .001) than the HIV- children. Among the HIV+ subjects, antiretroviral users had lower viral loads (P < .001) and lower levels of Candida spp. (P < .05) and total SIgA (P < .05) compared with antiretroviral nonusers.

CONCLUSIONS

The use of antiretroviral therapy was associated with decreases in the prevalence of oral candidiasis. This diminished exposure to Candida spp. was accompanied by decreases in levels of total and Candida-specific SIgA.

Salivary microbiota of HIV-positive children and its correlation with HIV status, oral diseases, and total secretory IgA

AIM

This study aimed to investigate the prevalence and levels of salivary microorganisms in HIV-positive children, and their correlation to HIV status, oral lesions, and salivary IgA levels.

DESIGN

Forty-two HIV-positive and 36 control children were clinically examined, had their saliva collected and processed for the microbiological analysis of 38 bacterial taxa by the checkerboard method, and salivary IgA quantification by ELISA.

RESULTS

The majority of the species tested were more prevalent in control children than in the HIV group. Mean concentration of total salivary IgA was similar in both groups. High levels of Veillonella parvula were found in children with cheilitis and herpes. Tannerella forsythia, Eikenella Corrodens, and Propionibacterium acnes were prevalent in children with gingivitis, while Fusobacterium periodonticum, Streptococcus gordonii, and Streptococcus oralis were significantly more frequent in children with no oral lesions. Significant negative correlations between salivary IgA levels and Eubacterium nodatum and oral streptococci were observed (P < 0.05).

CONCLUSION

HIV-seropositive children presented significantly lower prevalence and levels of several bacterial species in saliva; HIV-positive children are able to mount a mucosal immune response; HIV-seropositive children under highly active antiretroviral therapy presented low prevalence of oral lesions.

Dental care and HIV-infected individuals: are they equally treated?

OBJECTIVE

To investigate the problems in seeking dental care faced by HIV-positive individuals in Italy.

METHODS

A multicenter observational study was performed by distributing an anonymous self-administered questionnaire to patients of six public healthcare facilities specialized in the treatment of individuals with HIV infection. The questions concerned personal data potentially correlated with discrimination, the patient-dentist relationship before and after HIV diagnosis, and the reasons for seeking dental care in public facilities. We also evaluated the patients' discomfort in the patient-dentist relationship after HIV diagnosis, performing univariate and multivariate analyses.

RESULTS

Of the 1,500 questionnaires distributed; 883 were filled-out completely. A total of 630 persons received dental care after HIV diagnosis: 209 (33.2%) did not tell the dentist that they were seropositive. Of those who did, 56 were refused care. For patients treated by a private dentist, having been treated by the same dentist before diagnosis was a risk factor for great discomfort in the patient-dentist relationship (P < 0.002). Being treated in public facilities was associated with having received dental care after HIV diagnosis (P < 0.001) and a primary school education (P < 0.001).

CONCLUSIONS

There exist episodes of discrimination on the part of some dentists, and a relatively high proportion of HIV-positive persons do not disclose their seropositivity to the dentist. Dentists should be provided with training for promoting both ethically acceptable practices and suitable clinical management of HIV-positive persons.

Longitudinal study of the prevalence and prognostic implications of oral manifestations in romanian children infected with human immunodeficiency virus type 1

OBJECTIVE

We evaluated the prevalence and predictive value for human immunodeficiency virus (HIV) disease progression of oral manifestations in Romanian children.

METHODS

A nonrandom sample of 238 HIV-infected children was followed prospectively between 1998 and 2001 at the Romanian-American Children's Center in Constanta, Romania. Study subjects underwent comprehensive annual oral examinations. Oral manifestations of interest, demographic data and other selected medical information were recorded at baseline and at each subsequent visit. Descriptive statistics and survival analysis methods were used in the study. A level of statistical significance of alpha = 0.05 was used.

RESULTS

The study subjects' mean age was 9.9 +/- 1.2 (SD) years. The most common oral lesions were gingivitis (49%), parotid enlargement (13%) and oral candidiasis (11%). Oral candidiasis was associated with progression to acquired immunodeficiency syndrome or death (whichever occurred first) (log rank P = 0.03) and with death (log rank P < 0.001). Oral hairy leukoplakia also was associated with progression to death (log rank P = 0.001). The risk of dying was 3.43 (95% confidence interval, 1.86-6.34; P < 0.001) for children who had oral candidiasis at baseline and 4.62 (95% confidence interval, 1.67-12.77; P = 0.003) for those who had oral hairy leukoplakia.

CONCLUSIONS

Oral manifestations occur commonly among HIV-infected Romanian children. Oral candidiasis and oral hairy leukoplakia were positive predictors of HIV disease progression.

Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study

The goal of this study was to evaluate skeletal, dental and chronological development in an HIV-positive group of children, as compared with a control group, during a four-year period. Panoramic radiographs and hand and wrist radiographs of 60 children were taken. The children, of both sexes, aged 5 years and 2 months to 15 years and 5 months, were selected as follows: 30 HIV-positive volunteers who had acquired the disease vertically, and 30 volunteers who did not present the HIV infection or any other systemic disease. All radiographs were technically standardized and analyzed according to criteria established by Nolla (dental age), Greulich and Pyle (bone age), and Eklöf and Ringertz (bone age). The results were submitted to Student's t-test at a 5% level of significance. Based on the comparison between the chronological age and the dental or the skeletal age, significant differences were observed between HIV-positive and HIV-negative children, both in 1999 and in 2003 (p < or = 0.05). Considering the results obtained with the methodology used, it was concluded that HIV-positive children of both sexes presented delayed bone development despite the administration of antiretroviral drugs, and that HIV-positive female children presented younger dental ages compared with their chronological ages in 1999 and in 2003; and HIV-positive males, in 1999.

Delayed tooth eruption: pathogenesis, diagnosis, and treatment. A literature review

Delayed tooth eruption (DTE) is the emergence of a tooth into the oral cavity at a time that deviates significantly from norms established for different races, ethnicities, and sexes. This article reviews the local and systemic conditions under which DTE has been reported to occur. The terminology related to disturbances in tooth eruption is also reviewed and clarified. A diagnostic algorithm is proposed to aid the clinician in the diagnosis and treatment planning of DTE. The sequential and timely eruption of teeth is critical to the timing of treatment and the selection of an orthodontic treatment modality. This review addresses the need for a more in-depth understanding of the underlying pathophysiology of DTE and gives the clinician a methodology to approach its diagnosis and treatment.

Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients

The aim of the study was to compare dental caries status and the number and type of oral mucosal lesions in HIV positive children from a hospital outpatient department and an institutionalized setting. Oral examinations were performed using presumptive diagnostic criteria. The Fisher's Exact and the Mann-Whitney tests were used for statistical comparison of the two study groups. A total of 169 children were examined of whom 42% were institutionalized and 58% hospital outpatients. One institutionalized child presented with Noma. Twenty-one percent of the institutionalized population presented with molluscum contagiosum, while none of the hospital outpatients presented with this condition. Significantly more intraoral mucosal lesions were observed in the hospital compared with the institutionalized group. The most frequently encountered oral lesion was candidiasis. Pseudomembranous candidiasis was the most common type. Twice as many intraoral ulcers were recorded in the institutionalized group. Thirty-nine percent of the hospitalized patients had multiple lesions compared with 28% in the institutionalized group. Almost three quarters of both populations were caries-free. The mean DMFT was considerably higher in the hospital population. For both the permanent and primary teeth, the decayed component (D/d) made up the major part of the DMFT/dmft, followed by the missing (M/m) component. No fillings were recorded in either the primary or permanent teeth for both groups. Oral lesions are common in HIV populations and were seen in both the hospital and institutionalized groups, at high prevalence levels (63 and 45%). HIV infected children should be considered high risk for caries because of the use of chronic medications, and to receive appropriate care in terms of both treatment and services.

HIV disease in primary care

During the past decade, a large number of new drugs for treating HIV and its complications have been developed. The increasingly sophisticated use of these drugs in combination has led to a marked reduction in HIV-related morbidity and mortality in countries where they are available. HIV/AIDS patients receiving treatment are now expected to live into old age. The beneficial effect of HIV treatment has resulted in an expanding population of persons living with HIV/AIDS who will need the care of an HIV specialist because of the complexity of the treatment regimens and the rapidly changing HIV/AIDS knowledge base. However, this growing and aging population will also benefit from the care of a primary care physician. The primary care generalist is in the best position to recognize and diagnose HIV infection, evaluate HIV risk in his or her patient population, and help prevent HIV infection in persons at risk. In patients known to be infected, the primary care generalist will be best able to manage hyperlipidemia, diabetes, cardiovascular disease, and other disorders of an aging population with an increased risk of these and other conditions. Patients with HIV infection frequently accumulate a large number of specialist physicians, and the unique ability of the primary care physician to monitor their care and act as a knowledgeable patient advocate is a great benefit to the patient.