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Cao P, Zhang Y, Dong G, Wu H, Yang Y, Liu Y. Clinical Oral Condition Analysis and the Influence of Highly Active Antiretroviral Therapy on Human Salivary Microbial Community Diversity in HIV-Infected/AIDS Patients. Front Cell Infect Microbiol 2022; 12:937039. [PMID: 35846778 PMCID: PMC9277119 DOI: 10.3389/fcimb.2022.937039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to assess the clinical oral status and investigate the effect of highly active antiretroviral therapy (HAART) on oral flora diversity in human immunodeficiency virus (HIV)-infected/acquired immune deficiency syndrome (AIDS) patients. We first recorded and analyzed the demographic indicators of 108 HIV-infected patients and assessed their periodontal health, dental health and oral lesion status by oral examination. Besides, we compared the changes in salivary microbial communities of healthy controls, before and after treatment of HAART-processed AIDS patients by Roche 454 sequencing and RT-qPCR. In HIV-infected/AIDS patients, age, sex, marital status, income level, smoking and oral health behaviors had an effect on periodontal clinical indicators; age and marital status were correlated with dental clinical indicators; most of them were accompanied by oral manifestations, mainly including candidiasis albicans, salivary gland disease, AIDS-associated periodontitis, and oral ulcers. Besides, a total of 487 species were detected in the saliva of AIDS patients. The microbial communities of HAART-unprocessed AIDS patients significantly differed from those processed patients, with 112 unique microbial species. More importantly, a large number of conditioned pathogens were also detected in the saliva samples of AIDS patients, which may be associated with opportunistic infections. Therefore, HAART might have a crucial role in salivary microecological balance in AIDS patients. And these patients should pay attention to the maintenance of oral health, and the early initiation of HAART may be important for the development of oral lesions.
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Affiliation(s)
- Peilin Cao
- Department of Stomatology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yifan Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Stomatology, Hangzhou Dental Hospital Group, Hangzhou, China
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Guangyan Dong
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hongkun Wu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuxiang Yang
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yuxiang Yang, ; Yi Liu,
| | - Yi Liu
- Department of Stomatology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Yuxiang Yang, ; Yi Liu,
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Woldu M, Minzi O, Engidawork E. Prevalence of cardiometabolic syndrome in HIV-infected persons: a systematic review. J Diabetes Metab Disord 2020; 19:1671-1683. [PMID: 33553042 PMCID: PMC7843841 DOI: 10.1007/s40200-020-00552-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/21/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION HIV infected persons are twofold likely to experience a heart attack, stroke, and other forms of Cardiometabolic Syndrome (CMetS). METHODS Electronic searches of databases (MEDLINE and Google Scholar) were queried for articles written in English from 2000 to 2019. RESULTS In this review (16 publications), a total of 14,002 participants from 8 countries were included. Two continents contributed to 62.5% of the CMetS studies while 38.1% from Latin America and 24.4% from North America. The studies were conducted in 113 different centers, with an average study length of 2.8 years. The majority of the study designs were cross-sectional (62%) followed by a cohort study (25%) and clinical trials (12.5%). The mean age of the population enrolled was 41.9 years and 54.6% of the participants were males. The overall prevalence of CMetS using the National Cholesterol Education Adult Treatment Panel definition was 20.6%. Only 31.3% of the studies were reported using the International Diabetes Federation definition. Smoking and high blood pressure were reported as a risk factor in 62.5% of the studies, while diabetes (31.3%), family history of CMetS (25%), and cardiac vascular and cancer diseases were reported in 12.5% of the studies. The average duration of stay with HIV after confirmation was 5.23 + 1.4 (years + SD) and the median duration on HAART was 4.5 + 2.3 (years + SD). CONCLUSIONS CMetS was a common problem among HIV infected persons. Several RFs can contribute to the development of CMetS with smoking and hypertension highly interrelated. PROSPERO-NUMBER CRD42018107187.
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Affiliation(s)
- Minyahil Woldu
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es-Salaam, Tanzania
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Churchill Avenue, 9086 Addis Ababa, Ethiopia
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es-Salaam, Tanzania
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Churchill Avenue, 9086 Addis Ababa, Ethiopia
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Fidel PL, Moyes D, Samaranayake L, Hagensee ME. Interplay between oral immunity in HIV and the microbiome. Oral Dis 2020; 26 Suppl 1:59-68. [PMID: 32862522 DOI: 10.1111/odi.13515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This Basic Science Workshop addressed the oral microbiome. At the 7th World Workshop on Oral Health & Disease in HIV/AIDS in India in 2014, some aspects of the human microbiome were discussed, and research questions formulated. Since that time, there have been major advances in technology, which have stimulated a number of publications on many aspects of the human microbiome, including the oral cavity. This workshop aimed to summarize current understanding of the "normal" microbiome of the oral cavity compared to that during HIV infection, and how oral immune factors and other clinical variables alter or control the oral microbiome. An important question is whether successful treatment with anti-retroviral therapy, which leads to a significant drop in viral loads and immune reconstitution, is associated with any change or recovery of the oral microbiome. Additionally, the workshop addressed the issue of which parameters are most appropriate/correct to evaluate the oral microbiome and how clinically relevant are shifts/changes in the oral microbiome. The workshop evaluated current knowledge in five research areas related to five basic questions and identified further topics where further research is required.
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Affiliation(s)
- Paul L Fidel
- LSU Health School of Dentistry, New Orleans, LA, USA
| | - David Moyes
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Ryder MI, Shiboski C, Yao TJ, Moscicki AB. Current trends and new developments in HIV research and periodontal diseases. Periodontol 2000 2020; 82:65-77. [PMID: 31850628 DOI: 10.1111/prd.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the advent of combined antiretroviral therapies, the face of HIV infection has changed dramatically from a disease with almost certain mortality from serious comorbidities, to a manageable chronic condition with an extended lifespan. In this paper we present the more recent investigations into the epidemiology, microbiology, and pathogenesis of periodontal diseases in patients with HIV, and the effects of combined antiretroviral therapies on the incidence and progression of these diseases both in adults and perinatally infected children. In addition, comparisons and potential interactions between the HIV-associated microbiome, host responses, and pathogenesis in the oral cavity with the gastrointestinal tract and other areas of the body are presented. Also, the effects of HIV and combined antiretroviral therapies on comorbidities such as hyposalivation, dementia, and osteoporosis on periodontal disease progression are discussed.
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Affiliation(s)
- Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anna-Barbara Moscicki
- Division of Adolescent Medicine, Department of Pediatrics, University of California, Los Angeles, California, USA
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Vernon LT, Seacat JD, Demko CA, Paes B da Silva A, Zyzanski SJ. A provider-observed tool to assess Oral Hygiene Skill Mastery (OHSIM) in human immunodeficiency virus-positive (HIV+) adults. SPECIAL CARE IN DENTISTRY 2019; 39:147-157. [PMID: 30758061 DOI: 10.1111/scd.12355] [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: 06/26/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
AIMS Periodontal diseases (PDs) affect nearly half of Americans ≥30 years old and are common in human immunodeficiency virus-positive (HIV+) adults. A validated measure of oral hygiene skill could improve tailored prevention-focused health communication. METHODS We developed Oral Hygiene Skill Mastery (OHSIM), a provider-observed measure of toothbrushing and flossing ability. We examined OHSIM's inter-rater reliability (IRR) and concurrent validity using a blinded, cross-sectional study design with a convenience sample of HIV+/- adults. Clinical outcome measures included bleeding on probing (BOP) and abbreviated plaque and gingival indices. Analyses included IRR and, after identifying relevant predictor variables for each outcome, backward elimination regression and structural equation modeling (SEM) were used to demonstrate concurrent validity. RESULTS We saw 173 research participants (reliability: n = 61; validity: n = 112). The average IRR was α = 0.73 for toothbrushing and α = 0.84 for flossing. Toothbrushing and flossing skill were moderately correlated (r = 0.49, P < 0.001). SEM analyses demonstrated that OHSIM toothbrushing significantly and independently predicted variance in plaque and gingival indices and BOP, while OHSIM flossing skill significantly and independently predicted plaque index and BOP. CONCLUSION OHSIM is a provisionally reliable and valid provider-observed measure of toothbrushing and flossing skill. Most predictors of clinical outcomes were modifiable behaviors. Toothbrushing quality is a critical component of oral health.
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Affiliation(s)
- Lance T Vernon
- Department of Pediatric Dentistry and Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio.,VA Quality Scholars Fellowship Program, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jason D Seacat
- Department of Psychology, Western New England University, Springfield, Massachusetts
| | - Catherine A Demko
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Andre Paes B da Silva
- Department of Periodontology, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Stephen J Zyzanski
- Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Alterations in the oral microbiome in HIV-infected participants after antiretroviral therapy administration are influenced by immune status. AIDS 2018; 32:1279-1287. [PMID: 29851662 DOI: 10.1097/qad.0000000000001811] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To characterize the oral bacterial microbiome in HIV-infected participants at baseline and after 24 weeks of EFV/FTC/TDF. DESIGN Thirty-five participants co-enrolled in two AIDS Clinical Trials Group (ACTG) studies, A5272 and A5280, with paired saliva samples and complete data sets were assessed. METHODS Paired saliva samples were evaluated for bacterial microbiome using 16S rDNA PCR followed by Illumina sequencing. Diversity and differential abundance was compared between groups. A random forest classification scheme was used to determine the contribution of parameters in classifying participants' CD4+ T-cell count. RESULTS Bacterial communities demonstrated considerable variability both within participants and between timepoints, although they became more similar after 24 weeks of ART. At baseline, both the number of taxa detected and the average alpha diversity were variable between participants, but did not differ significantly based on CD4+ cell count, viral load or other factors. After 24 weeks of ART samples obtained from participants with persistently low CD4+ T-cell counts had significantly higher bacterial richness and diversity. Several differentially abundant taxa, including Porphyromonas species associated with periodontal disease, were identified, which discriminated between baseline and posttreatment samples. Analysis demonstrated that although inflammatory markers are important in untreated disease, the salivary microbiome may play an important role in CD4+ T-cell count recovery after ART. CONCLUSION Shifts in the oral microbiome after ART initiation are complex, and may play an important role in immune function and inflammatory disease.
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Berquist VL, Hearps AC, Ford P, Jaworowski A, Leishman SJ, Hoy JF, Trevillyan JM. Porphyromonas gingivalis antibody levels and diagnosis of coronary artery disease in HIV-positive individuals. J Periodontal Res 2017; 52:930-935. [PMID: 28397248 DOI: 10.1111/jre.12460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Periodontal disease has been associated with cardiovascular disease in the general population. It is unknown whether IgG antibody levels for periodontal pathogens are associated with the diagnosis of coronary artery disease (CAD) in HIV-positive individuals. MATERIAL AND METHODS Twenty-four HIV-positive individuals (cases) with stored plasma available in the 12 months before CAD diagnosis were age- and sex-matched 1:2 with 46 HIV-positive individuals without CAD (controls). Antibody levels to whole cell extracts from periodontal pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum, as well as markers of inflammation sCD14, CXCL10 and high-sensitivity C-reactive protein, were compared between cases and controls using enzyme-linked immunosorbent assays. RESULTS P. gingivalis-specific IgG levels (μg/mL) were significantly higher in individuals with CAD (median 1.48 [IQR 1.06-2.05]) compared to controls (0.70 [IQR 0.35-1.24], P<.001), and remained significantly higher following adjustment for traditional cardiovascular risk factors and HIV viral load (OR 21.6 [95% CI 3.73-125.63] P=.001). There was a borderline association between A. actinomycetemcomitans IgG antibody levels (cases, median 3.86 [IQR 3.19-4.72]; controls, 3.34 [IQR 2.59-4.07], P=.050) and no association found between F. nucleatum antibody levels and CAD. sCD14 levels (μg/mL) were higher in cases compared with controls (median 3.45 [IQR 3.03-4.11] vs 2.65 [IQR 2.32-2.99] P<.001), while CXCL10 (median 127 pg/mL [IQR 88-157] vs 153 [IQR 90-244] P=.321) and high-sensitivity C-reactive protein (median 3.44 mg/L [1.98-5.32] vs 1.85 [1.13-6.88] P=.203) levels were not different between cases and controls. CONCLUSION Periodontal bacteria may be contributing to CAD risk in HIV-positive individuals.
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Affiliation(s)
- V L Berquist
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia
| | - A C Hearps
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia.,Centre for Biomedical Research, Burnet Institute, Melbourne, Vic., Australia
| | - P Ford
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - A Jaworowski
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia.,Centre for Biomedical Research, Burnet Institute, Melbourne, Vic., Australia
| | - S J Leishman
- School of Dentistry, The University of Queensland, Brisbane, Qld, Australia
| | - J F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia
| | - J M Trevillyan
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic., Australia
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Ryder MI, Yao TJ, Russell JS, Moscicki AB, Shiboski CH. Prevalence of periodontal diseases in a multicenter cohort of perinatally HIV-infected and HIV-exposed and uninfected youth. J Clin Periodontol 2016; 44:2-12. [PMID: 27801947 DOI: 10.1111/jcpe.12646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Abstract
AIMS To compare the prevalence and severity of periodontal diseases between 180 perinatally HIV-infected (PHIV) and 118 perinatally HIV-exposed and uninfected (PHEU) youth in a cross-sectional study conducted at 11 clinical sites in the United States and Puerto Rico from the Adolescent Master Protocol study of the Pediatric HIV/AIDS cohort study (PHACS) network. METHODS Several analyses were conducted, employing the current CDC/AAP classification for periodontitis and incorporating a definition of gingivitis based on a bleeding on probing (BOP) threshold, and analyses based on more detailed whole-mouth, intra-oral regionally, site-based and tooth-based criteria of BOP, plaque levels, pockets depths and clinical attachment levels. RESULTS After adjusting for plaque control habits and behavioural and sociodemographic factors, there were no significant differences in periodontal diseases between the PHIV and PHEU youth using any of these criteria. For PHIV youth, there was no significant association between parameters of periodontal disease and current HIV status. CONCLUSIONS Although no significant differences in periodontal parameters were noted between the PHIV and PHEU youth, the influence of antiretroviral therapy merits further exploration in this cohort in a longitudinal study.
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Affiliation(s)
- Mark I Ryder
- Division of Periodontology, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jonathan S Russell
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna-Barbara Moscicki
- Division of Adolescent Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Caroline H Shiboski
- Division of Oral Medicine, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
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Mehlotra RK, Hall NB, Willie B, Stein CM, Weinberg A, Zimmerman PA, Vernon LT. Associations of Toll-Like Receptor and β-Defensin Polymorphisms with Measures of Periodontal Disease (PD) in HIV+ North American Adults: An Exploratory Study. PLoS One 2016; 11:e0164075. [PMID: 27727278 PMCID: PMC5058471 DOI: 10.1371/journal.pone.0164075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022] Open
Abstract
Polymorphisms in toll-like receptor (TLR) and β-defensin (DEFB) genes have been recognized as potential genetic factors that can influence susceptibility to and severity of periodontal diseases (PD). However, data regarding associations between these polymorphisms and PD are still scarce in North American populations, and are not available in HIV+ North American populations. In this exploratory study, we analyzed samples from HIV+ adults (n = 115), who received primary HIV care at 3 local outpatient HIV clinics and were monitored for PD status. We genotyped a total of 41 single nucleotide polymorphisms (SNPs) in 8 TLR genes and copy number variation (CNV) in DEFB4/103A. We performed regression analyses for levels of 3 periodontopathogens in subgingival dental plaques (Porphyromonas gingivalis [Pg], Treponema denticola [Td], and Tannerella forsythia [Tf]) and 3 clinical measures of PD (periodontal probing depth [PPD], gingival recession [REC], and bleeding on probing [BOP]). In all subjects combined, 2 SNPs in TLR1 were significantly associated with Td, and one SNP in TLR2 was significantly associated with BOP. One of the 2 SNPs in TLR1 was significantly associated with Td in Caucasians. In addition, another SNP in TLR1 and a SNP in TLR6 were also significantly associated with Td and Pg, respectively, in Caucasians. All 3 periodontopathogen levels were significantly associated with PPD and BOP, but none was associated with REC. Instrumental variable analysis showed that 8 SNPs in 6 TLR genes were significantly associated with the 3 periodontopathogen levels. However, associations between the 3 periodontopathogen levels and PPD or BOP were not driven by associations with these identified SNPs. No association was found between DEFB4/103A CNV and any periodontopathogen level or clinical measure in all samples, Caucasians, or African Americans. Our exploratory study suggests a role of TLR polymorphisms, particularly TLR1 and TLR6 polymorphisms, in PD in HIV+ North Americans.
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Affiliation(s)
- Rajeev K. Mehlotra
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail: (RKM); (LTV)
| | - Noemi B. Hall
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Barne Willie
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Catherine M. Stein
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
- Center for Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Aaron Weinberg
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Peter A. Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Lance T. Vernon
- Department of Pediatric and Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
- * E-mail: (RKM); (LTV)
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Vernon LT, Jayashantha P, Chidzonga MM, Komesu MC, Nair RG, Johnson NW. Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report. Oral Dis 2016; 22 Suppl 1:135-48. [PMID: 27109282 PMCID: PMC5986297 DOI: 10.1111/odi.12412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.
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Affiliation(s)
- L T Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Plp Jayashantha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia and Dental Hospital, and Sri Lanka Air Force Station Colombo, Sri Lanka, Australia
| | - M M Chidzonga
- College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - M C Komesu
- Department of Morphology, Stomatology Physiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - R G Nair
- Oral Medicine, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia and Cancer Services, Gold Coast University Hospital, Queensland Health, Qld, Autralia, Australia
| | - N W Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
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Vernon LT, Howard AR. Advancing Health Promotion in Dentistry: Articulating an Integrative Approach to Coaching Oral Health Behavior Change in the Dental Setting. ACTA ACUST UNITED AC 2015; 2:111-122. [PMID: 26457237 DOI: 10.1007/s40496-015-0056-9] [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: 10/23/2022]
Abstract
Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients' oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients' knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned.
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Affiliation(s)
- Lance T Vernon
- School of Dental Medicine, Department of Pediatric Dentistry and Community Dentistry, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4905, USA
| | - Anita R Howard
- Weatherhead School of Management, Department of Organizational Behavior, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4905, USA
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Patel N, Furin JJ, Willenberg DJ, Apollon Chirouze NJ, Vernon LT. HIV-related stigma in the dental setting: a qualitative study. SPECIAL CARE IN DENTISTRY 2014; 35:22-8. [PMID: 25039662 DOI: 10.1111/scd.12078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To explore the experiences and expectations of HIV-related stigma in dental settings. METHODS This was a cross-sectional study of 60 HIV+ adult volunteers. We conducted audio-recorded interviews; responses to four open-ended questions were analyzed qualitatively for theme and content. RESULTS Twenty-seven participants (45%) reported ever having anticipated being judged, stigmatized or treated with disrespect in a dental setting due to HIV status. Thematic response categories included concerns about: (i) receiving humane and respectful treatment, (ii) being judged or stereotyped and (iii) giving HIV to the dentist. Regarding hesitancy to visit the dentist, subjects equally endorsed fear of the dentist (35%) and concerns about confidentiality and receiving humane treatment (35%). CONCLUSION HIV+ individuals encounter many fears and concerns related to dental care; fear of the dentist and concerns about confidentiality and receiving humane treatment appear to be central issues. Dental providers should be aware of and better manage these issues.
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Affiliation(s)
- Natisha Patel
- Dental Student (Y2), Ohio State University School of Dentistry, work performed at Case Western Reserve University, Department of Biological Sciences
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13
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Zhu H, Yuan J, Wei C, Chen J, Wang Y. Evaluation of right ventricular function by Doppler tissue imaging of the tricuspid annulus in patients with acquired immune deficiency syndrome. Exp Ther Med 2014; 7:747-749. [PMID: 24520280 PMCID: PMC3919889 DOI: 10.3892/etm.2014.1480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/23/2013] [Indexed: 01/14/2023] Open
Abstract
Chronic heart disease contributes to the mortality of patients with AIDS. Although studies of left ventricular function in patients with acquired immune deficiency syndrome (AIDS) have been conducted, studies of right ventricular function are rare. The present study aimed to characterize the tricuspid annulus movement and evaluate the right ventricular function of patients with AIDS by tissue Doppler imaging. Tissue Doppler echocardiography was performed on 106 patients with AIDS and 64 controls. Tricuspid annulus movements were detected from the apical four-chamber view and the apical right heart two-chamber view. The peak diastolic early period velocity (Ve), peak diastolic later period velocity (Va) and peak systolic velocity (Vs) were measured at the anterior, posterior and lateral walls and also at the interventricular septum. Mean values were calculated, as well as the Tei index of the lateral site. Compared with the values in the control group, the Vs and Va of the AIDS group decreased at all sites with the exception of the lateral wall, whereas the Ve decreased at all sites of the tricuspid annulus (P<0.05). The Tei index was higher in the AIDS group than in the control (P<0.05). The results obtained in the present study show that the function of the right ventricle decreases in patients with AIDS, which is indicative of susceptibility to right ventricular dysfunction.
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Affiliation(s)
- Haohui Zhu
- Department of Ultrasound Diagnostics, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Jianjun Yuan
- Department of Ultrasound Diagnostics, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Changhua Wei
- Department of Ultrasound Diagnostics, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Jiyun Chen
- Department of Ultrasound Diagnostics, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yisa Wang
- Department of Ultrasound Diagnostics, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
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14
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Vernon LT, Demko CA, Babineau DC, Wang X, Toossi Z, Weinberg A, Rodriguez B. Effect of Nadir CD4+ T cell count on clinical measures of periodontal disease in HIV+ adults before and during immune reconstitution on HAART. PLoS One 2013; 8:e76986. [PMID: 24146949 PMCID: PMC3795634 DOI: 10.1371/journal.pone.0076986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD. METHODS We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥ 1 site with periodontal probing depth (PPD) ≥ 5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥ 4.0mm, and bleeding on probing (BOP) at ≥ 4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD. RESULTS Forty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD. CONCLUSION Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.
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Affiliation(s)
- Lance T. Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Catherine A. Demko
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Denise C. Babineau
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Xuelei Wang
- Center for Clinical Investigation, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Zahra Toossi
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Aaron Weinberg
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Benigno Rodriguez
- Center for AIDS Research, Case Western Reserve University/University Hospitals of Cleveland, Cleveland, Ohio, United States of America
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15
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Abstract
Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.
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16
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Longenecker CT, Hoit BD. Imaging atherosclerosis in HIV: carotid intima-media thickness and beyond. Transl Res 2012; 159:127-39. [PMID: 22340762 DOI: 10.1016/j.trsl.2011.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 10/15/2022]
Abstract
Chronic immune activation and inflammation are associated with an increased risk of atherosclerosis in HIV-infected patients. In this review, we discuss the role of established and novel imaging modalities to define more accurately the structure and function of inflammation-mediated atherosclerosis in the context of HIV. Historically, carotid ultrasound studies were the first to show higher rates of subclinical atherosclerosis in HIV-infected subjects versus uninfected controls. However, computed tomography is the noninvasive gold standard for imaging the coronary arteries, and studies in HIV suggest a higher prevalence of noncalcified plaque. Endothelial dysfunction can be quantified by measuring flow-mediated brachial artery dilation by ultrasound and has been used extensively in antiretroviral switching trials and small pilot trials of therapeutics to assess cardiovascular risk in this population. In the future, novel imaging modalities such as intracoronary optical coherence tomography, positron emission tomography imaging of (18)F-fluorodeoxyglucose uptake, and molecular-targeted magnetic resonance imaging will characterize the burden of vulnerable plaque and other unique features of inflammatory atherosclerosis in HIV.
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Affiliation(s)
- Chris T Longenecker
- Harrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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