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Ntolou P, Pani P, Panis V, Madianos P, Vassilopoulos S. The effect of antiretroviral therapyon the periodontal conditions of patients with HIV infection: A systematic review and meta-analysis. J Clin Periodontol 2023; 50:170-182. [PMID: 36261851 DOI: 10.1111/jcpe.13735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 01/18/2023]
Abstract
AIM To assess any differences (1) in the prevalence of periodontitis and necrotizing periodontal diseases, specifically necrotizing gingivitis (NG) and necrotizing periodontitis (NP) between HIV patients receiving antiretroviral therapy (HAART) and those not receiving the therapy and (2) in the severity of periodontitis based on probing depths (PDs) and clinical attachment loss (CAL) between the two groups. MATERIALS AND METHODS Systematic electronic search on five databases (PubMed, Google Scholar, Scopus, Web of Science and Scielo) was conducted to identify cross-sectional and longitudinal studies reporting on prevalence of NG, NP and periodontitis among HIV patients who either receive or do not receive HAART treatment. The differences in clinical parameters of PDs and CAL among these patients were assessed. RESULTS Eighteen articles were considered. The meta-analysis for NG showed that the overall assessment for the relative frequency ratio in the two groups was 0.45 (n = 7; 95% confidence interval [CI]: [0.21, 0.97]; p < .042). Regarding NP, the overall assessment for the relative frequency ratio in both groups was 0.60 (n = 5; 95% CI [0.22, 1.64]; p = .321). With regard to periodontitis, the overall assessment for the relative frequency ratio in the two groups was 1.17 (n = 9; 95% CI [0.90, 1.52]; p = .248). No significant differences in PD and CAL were found between the two groups 0.00 (n = 3; 95% CI [-0.52, -0.53]; p = .985) and 0.32 (n = 3; 95% CI [-0.19, 0.82]; p = .22), respectively. CONCLUSIONS The prevalence of NG appeared to be significantly reduced in patients receiving antiretroviral therapy. No statistical significant difference was found in the prevalence of NP or periodontitis between the two groups.
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Affiliation(s)
- Panagiota Ntolou
- Department of Periodontology, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
| | - Pinelopi Pani
- Department of Periodontology, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Vassileios Panis
- Department of Periodontology, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
| | - Phoebus Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
| | - Spyridon Vassilopoulos
- Department of Periodontology, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
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Moosazadeh M, Shafaroudi AM, Gorji NE, Barzegari S, Nasiri P. Prevalence of oral lesions in patients with AIDS: a systematic review and meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0209-8. [PMID: 34795396 DOI: 10.1038/s41432-021-0209-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
Background Oral lesions are considered to be early clinical signs which may predict the progression of patients with acquired immune deficiency syndrome (AIDS). Due to the lack of a comprehensive study that includes oral lesions in people with AIDS, the global prevalence of oral lesions in people with AIDS was estimated by combining preliminary studies' results using meta-analysis.Material and methods Databases including PubMed, Science Direct and Scopus were searched using keywords as 'HIV', 'AIDS', 'oral candidiasis', 'Kaposi Sarcoma', 'LinearGingival Erythema' and OR operators, AND and NOT. After the elimination of duplicate documents, articles that met the inclusion criteria were selected. Quality assessment was performed based on the Newcastle-Ottawa Scale. After combining the results of preliminary studies, an overall estimate of each lesion was reported. Ninety-five studies met the criteria for inclusion in this meta-analysis.Results The global prevalence of 21 oral lesions in HIV-infected patients was estimated. The overall prevalence of oral candidiasis, pseudomembranous candidiasis, oral hairy leukoplakia, Kaposi sarcoma and erythematous candidiasis was as follows: 35% (95% CI: 28-42), 19% (95% CI: 15-22), 12% (95% CI: 11-14), 5% (95% CI: 4-6) and 18% (95% CI: 14-22).Conclusion The present meta-analysis showed that oral lesions have a high prevalence in patients with AIDS. Dentists should consider that the clinical appearance of the oral cavity reflects the overall systemic health of the patient. As such, oral lesions may be linked to underlying immunosuppression caused by AIDS.
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Affiliation(s)
- Mahmood Moosazadeh
- PhD in Epidemiology, Associate Professor, Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Malekzadeh Shafaroudi
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nadia Elyassi Gorji
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Barzegari
- PhD in Health Information Management, Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Pegah Nasiri
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
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Lim G, Janu U, Chiou LL, Gandhi KK, Palomo L, John V. Periodontal Health and Systemic Conditions. Dent J (Basel) 2020; 8:E130. [PMID: 33227918 PMCID: PMC7711538 DOI: 10.3390/dj8040130] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 12/05/2022] Open
Abstract
According to the new classification proposed by the recent 2017 World Workshop on Periodontal and Peri-implant Diseases and Conditions, periodontitis, necrotizing periodontal diseases, periodontitis as a manifestation of systemic diseases, and systemic diseases or conditions affecting the periodontal supporting tissues, are considered as separate entities. Scientific evidence has demonstrated that periodontal diseases are not just simple bacterial infections but rather complex diseases of multifactorial complexity that interplay with the subgingival microbes, the host immune, and inflammatory responses. Despite dental plaque biofilm being considered the primary risk factor for periodontitis in the vast majority of patients that dentists encounter on a daily basis, there are other factors that can also contribute and/or accelerate pathologic progressive attachment loss. In this article, the authors aim to briefly review and discuss the present evidence regarding the association between periodontal diseases and systemic diseases and conditions.
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Affiliation(s)
- Glendale Lim
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN 46202, USA; (G.L.); (U.J.); (L.-L.C.); (K.K.G.)
| | - Upasna Janu
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN 46202, USA; (G.L.); (U.J.); (L.-L.C.); (K.K.G.)
| | - Lan-Lin Chiou
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN 46202, USA; (G.L.); (U.J.); (L.-L.C.); (K.K.G.)
| | - Kaveri Kranti Gandhi
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN 46202, USA; (G.L.); (U.J.); (L.-L.C.); (K.K.G.)
| | - Leena Palomo
- Department of Periodontology, Case Western University, School of Dentistry, Indianapolis, IN 46202, USA;
| | - Vanchit John
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN 46202, USA; (G.L.); (U.J.); (L.-L.C.); (K.K.G.)
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Maloth S, Shrinivas TR, Krishna Pramod B, Nagarathna P. Prevalence of oromucosal lesions in HIV positive patients receiving haart-A prospective clinical study. J Family Med Prim Care 2020; 9:4821-4825. [PMID: 33209807 PMCID: PMC7652119 DOI: 10.4103/jfmpc.jfmpc_881_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/14/2020] [Accepted: 07/20/2020] [Indexed: 01/29/2023] Open
Abstract
AIM To determine the preponderance of oral mucosal lesions and conditions in patients receiving highly active antiretroviral therapy (HAART) for Human Immunodeficiency virus (HIV). MATERIAL AND METHODS Patient tested Seropositive for HIV and on HAART therapy were clinically examined to evaluate prevalence of oral lesions. RESULTS In the pool of 152 HIV positive patients in the study, age ranged from 7 to 71 years, 67 were males and 85 females. The duration of the HAART medication was 43 months. Oral lesion was present in 51.32% of patients related to infection. Oral lesions seen in descending order of frequency were periodontitis, mucosal hyperpigmentation, acute gingivitis, oral candidiasis, linear gingival erythema, stomatitis, and nonspecific ulcers. Totally, 48.68% of patients had no oral lesions. CONCLUSION Majority of the HIV patients on HAART exhibited periodontitis (30.77%), mucosal hyperpigmentation (17.44%), gingivitis (10.77%), anemic stomatitis (11.28%), and other oral lesions accounted to 29.74% which may be attributed to Anti Retro Viral Therapy.
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Affiliation(s)
- Saritha Maloth
- Department of Dentistry, Koppal Institute of Medical Sciences, Koppal, Karnataka, India
| | - TR Shrinivas
- Department of Anesthesiology, Koppal Institute of Medical Sciences, Koppal, Karnataka, India
| | - B Krishna Pramod
- Department of Oral and Maxillofacial Surgery, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
| | - P.J. Nagarathna
- Department of Pedodontics and Preventive Dentistry, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
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Chaudhary P, Manral K, Gupta R, Bengani AKS, Chauhan BI, Arora D. Oral health status and treatment needs among HIV/AIDS patients attending antiretroviral therapy center in Western India: A cross-sectional study. J Family Med Prim Care 2020; 9:3722-3728. [PMID: 33102357 PMCID: PMC7567282 DOI: 10.4103/jfmpc.jfmpc_411_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
Aims and Objectives: Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem across the globe. Among 37.9 million people are living with HIV in the world and 21.40 lakh are in India itself. The aim of this study was to assess the oral mucosal, periodontal, and dentition status of HIV/AIDS patients attending ART (antiretroviral therapy) center in Jaipur city, India. Methods and Materials: A total of 588 HIV/AIDS subjects at the ART center in Jaipur city were examined. Oral mucosal, periodontal, and dentition status was recorded using a modified WHO Oral Health Assessment form 1997. A pilot study was conducted among 50 patients. The data were analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20.0. The statistical tests that were applied for the analysis included Chi-square test, Fisher exact test, and one-way analysis of variance (ANOVA). Results: Of 588 study subjects examined, 65.6% were men and 34.4% were women. Candidiasis was the most prevalent oral lesion (32.5%) followed by acute necrotizing gingivitis (26%), hyper melanotic pigmentation (15.8%), and ulcerations (8.7%), respectively. Oral hairy leukoplakia was observed in only 3.9% and not a single case of Kaposi's sarcoma was reported. Buccal mucosa (36.7%) was the most common site of the presence of oral mucosal lesions. The mean decayed, missing, and filled teeth (DMFT) score was 4.03 ± 1.54. Almost all the subjects needed one or other form of dental treatment. Only 12% of the patients had healthy periodontium. Conclusion: Candidiasis was the most prevalent oral lesion. Efforts should be made to meet the increased treatment needs in these patients.
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Affiliation(s)
- Pankaj Chaudhary
- Department of Public Health Dentistry, Daswani Dental College & Research Centre, Kota, Rajasthan, India
| | - Kanika Manral
- Department of Prosthodontics, Daswani Dental College & Research Centre, Kota, Rajasthan, India
| | - Rahul Gupta
- Department of Prosthodontics, Daswani Dental College & Research Centre, Kota, Rajasthan, India
| | - Aroon Kamal Singh Bengani
- Department of Oral and Maxillofacial Surgery, Daswani Dental College & Research Centre, Kota, Rajasthan, India
| | - Bhumit Ishvarlal Chauhan
- Department of Oral Medicine, Diagnosis and Radiology, Daswani Dental College & Research Centre, Kota, Rajasthan, India
| | - Deepanshu Arora
- Conservative and Endodontics, Daswani Dental College & Research Centre, Kota, Rajasthan, India
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El Howati A, Tappuni A. Systematic review of the changing pattern of the oral manifestations of HIV. ACTA ACUST UNITED AC 2018; 9:e12351. [PMID: 30019446 DOI: 10.1111/jicd.12351] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/20/2018] [Indexed: 11/27/2022]
Abstract
The purpose of the present study paper was to review the reported prevalence of the oral manifestations of HIV (OM-HIV) worldwide since 1980, and to determine the global variation in its prevalence over time. PubMed, Scopus, Embase and Google Scholar were searched. The filter "English" was used. The timeframe searched was 1980- 2015. The PRISMA flow chart was used. Data were extracted using the Joanna Briggs Institute standardized data extraction form and transferred to SPSS version 22 for analysis. The systematic review of 97 studies (70 low bias risk) showed that the prevalence of OM-HIV continue to be significant in developing countries. Globally and through all the decades, oral candidiasis remained the most commonly encountered OM-HIV, including among patients on antiretroviral therapy (ART) (26.2%). Hairy leukoplakia was more prevalent in Europe and America compared with Africa and Asia. Oral warts were reported more often in studies on patients receiving ART. Interestingly, salivary gland disease decreased in the developed world and increased in developing countries over time. Despite the changing pattern of these conditions over time, there is no evidence that the OM-HIV have become of less significance globally. Maintaining the drive for high-quality research in the subject will have an impact on less developed countries to help address oral health inequalities.
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Affiliation(s)
- Asma El Howati
- Department of Oral Medicine, Institute of Dentistry, Queen Mary University of London, London, UK.,Department of Oral Medicine, Faculty of Dentistry, Benghazi (Garyounis) University, Benghazi, Libya.,Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Libyan International Medical University, Benghazi, Libya
| | - Anwar Tappuni
- Department of Oral Medicine, Institute of Dentistry, Queen Mary University of London, London, UK
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Šembera M, Radochová V, Slezák R. Dental and Oral Lesions in HIV-Positive Individuals in East Bohemia--Czech Republic, Single Centre Experience. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 58:123-7. [PMID: 26960824 DOI: 10.14712/18059694.2016.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) continues to be a serious health issue and one of the world most devastating epidemics. An estimated 1.5 million people died from AIDS-related illnesses in 2013, and an estimated 37 million people with AIDS have died worldwide since the epidemic has begun. HIV infection is known for its oral manifestations which causes discomfort and pain for infected individuals. The objective of this study was to document oral conditions of HIV positive patients and the pattern and frequency of oral and dental lesions. METHODS All patients with confirmed HIV infection who were treated at the Department of Dentistry, University Hospital in Hradec Králové, were examined. RESULTS During the study period, 29 HIV positive patients were examined and treated--19 men, 10 women, with mean age of 32.9 years (range 22-58 years). 72.41% patients received ART. In total, all patients underwent 186 visits. The most frequent treatments were associated with teeth and periodontal lesions (71.80%), oral mucosal lesions were diagnosed and treated only in 3.96% cases. CONCLUSION Since the introduction of ART, the frequency of oral mucosal lesions is minimal in patients with HIV infection.
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Affiliation(s)
- Martin Šembera
- Department of Dentistry, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic.
| | - Vladimíra Radochová
- Department of Dentistry, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic
| | - Radovan Slezák
- Department of Dentistry, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Králové, Czech Republic
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HIV-Associated Oral Mucosal Melanin Hyperpigmentation: A Clinical Study in a South African Population Sample. AIDS Res Treat 2016; 2016:8389214. [PMID: 27006825 PMCID: PMC4783540 DOI: 10.1155/2016/8389214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/28/2016] [Indexed: 01/26/2023] Open
Abstract
Objective. The aim of the study was to determine the prevalence of HIV-associated oral mucosal melanin hyperpigmentation (HIV-OMH) in a specific population of HIV-seropositive South Africans and to analyse the associations between HIV-OMH clinical features and the demographic and immunological characteristics of the study cohort. Material and Methods. This cross-sectional study included 200 HIV-seropositive Black subjects. The collected data comprised age, gender, CD4+ T cell count, viral load, systemic disease, medications, oral site affected by HIV-OMH, extent (localized or generalized), intensity of the pigmentation (dark or light), and smoking and snuff use. Results. Overall, 18.5% of the study cohort had HIV-OMH. Twenty-two and a half percent had OMH that could not with confidence be attributed to HIV infection, and 59% did not have any OMH. There was a significant but weak association between smoking and the presence of HIV-OMH. Conclusions. The prevalence of HIV-OMH in the study population was 18.5%, the gingiva being the most commonly affected site. It appears that the CD4+ T cell count does not play any role in the biopathology of HIV-OMH.
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Sharma G, Oberoi SS, Vohra P, Nagpal A. Oral manifestations of HIV/AIDS in Asia: Systematic review and future research guidelines. J Clin Exp Dent 2015; 7:e419-27. [PMID: 26330942 PMCID: PMC4554245 DOI: 10.4317/jced.52127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/15/2015] [Indexed: 01/06/2023] Open
Abstract
Objectives The authors have conducted a systematic review of oral manifestations of HIV from studies conducted in Asia to establish the characteristics and prevalence of individual oral manifestations in Asia, and to assess the direction of future research studies on oral manifestations of HIV in Asia. Material and Methods The electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE], EBSCO, and EMBASE. The search was for limited articles published in English or with an English abstract and articles published during the period January 1995 to August 2014. The authors reached a final overall sample of 39 studies that were conducted in Asia. Results The median population size among all studies was 312.7 patients. Oral candidiasis [OC] was the most common oral manifestation [37.7%] in studies conducted in Asia. The overall prevalence of oral hairy leukoplakia and melanotic hyperpigmentation was computed to be 10.1% and 22.8% respectively. Thailand and India are primarily countries with maximum research on oral manifestations. Conclusions The research on oral manifestations of HIV in Asia has to upgrade to more interventional and therapeutic studies rather than the contemporary cross- sectional epidemiological descriptive studies. The authors have given suggestions and future directions for the implementation of clinical research of oral manifestations in HIV patients. Key words:Oral manifestations, HIV/AIDS, Asia, Systematic review.
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Affiliation(s)
- Gaurav Sharma
- Reader, Department of Oral Medicine, S.R. Dental College, Faridabad, Haryana, India-121002
| | - Sukhvinder-Singh Oberoi
- Reader, Department of Public Health Dentistry, S.R. Dental College, Faridabad, Haryana, India-121002
| | - Puneeta Vohra
- Reader, Department of Oral Medicine, S.G.T. Dental College, Gurgaon, Haryana, India
| | - Archna Nagpal
- Reader, Department of Oral Medicine, P.D.M. Dental College, Bahadurgarh, Haryana, India
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Patil N, Chaurasia VR, Babaji P, Ramesh D, Jhamb K, Sharma AM. The effect of highly active antiretroviral therapy on the prevalence of oral manifestation in human immunodeficiency virus-infected patients in Karnataka, India. Eur J Dent 2015; 9:47-52. [PMID: 25713484 PMCID: PMC4319299 DOI: 10.4103/1305-7456.149640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Acquired Immunodeficiency Syndrome (AIDS) is a highly lethal, progressively epidemic viral infection characterized by profound impairment of the immune system. Oral manifestations are common in Human Immunodeficiency Virus (HIV) infected AIDS patients, and are usually the first indicator of symptom and disease progression. The main objective of the current study was to compare the prevalence of oral manifestations in HIV patients on Highly Active Antiretroviral Therapy (HAART) with those, not on HAART therapies. MATERIALS AND METHODS A cross sectional study was conducted among 100 patients diagnosed as human immune virus sero-positive. These patients were divided equally into two groups (50 each); Group I patients on HAART and Group II patients who were not on HAART. Information regarding age, sex and cluster of differentiation 4 cell count was obtained from the medical records. Oral examination was done, and findings were recorded by using internationally accepted presumptive clinical criteria. Statistical analysis was performed using Chi-square statistical test. RESULTS The presence of oral manifestations was significantly decreased in subjects on HAART (32%) compared to those who are not on HAART (56%). The most common oral lesions detected in patients on HAART were increased oral hyper-pigmentation (14%), recurrent aphthous stomatitis (8%), non-specific ulcerations (4%), pseudo-membranous candidiasis (2%), periodontitis (2%) and xerostomia (2%), whereas in non HAART oral hyperpigmentation (10%), pseudo-membranous candidiasis (8%), angular cheilitis (4%), and erythematous candidiasis (4%) and Periodontitis (14%) were more prevalent. CONCLUSION The number and severity of oral manifestation decreased, and even there was a change in the type of oral manifestations on HAART, which may be because of the improvement in immunity gained by the therapy.
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Affiliation(s)
- Neelkant Patil
- Department of Oral Medicine, Vyas Dental College, Jodhpur, Rajasthan, India
| | | | - Prashant Babaji
- Department of Pedodontics, Vyas Dental College, Jodhpur, Rajasthan, India
| | - Dnsv Ramesh
- Department of Oral Medicine and Radiology, AME'S Dental College and Hospital, Raichur, Karnataka, India
| | - Kshitij Jhamb
- Department of Oral and Maxillofacial Surgery, Indraprasthaal College, Haryana, India
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Mortazavi H, Baharvand M, Movahhedian A, Mohammadi M, Khodadoustan A. Xerostomia due to systemic disease: a review of 20 conditions and mechanisms. Ann Med Health Sci Res 2014; 4:503-10. [PMID: 25221694 PMCID: PMC4160670 DOI: 10.4103/2141-9248.139284] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Xerostomia is a common complaint of nearly half of the elderly population and about one-fifth of younger adults. It causes several signs and symptoms, and compromise oral functions and health-related quality-of-life. Multiple reasons are proposed to describe the etiology of xerostomia such as local factors, psychogenic factors, and systemic diseases. In order to manage xerostomia effectively, identification of the main causality is mandatory. The aim of this review was to present systemic diseases leading to xerostomia with their mechanisms of action. We used various general search engines and specialized databases such as Google, Google Scholar, Yahoo, PubMed, PubMed Central, MedLine Plus, Medknow, EBSCO, ScienceDirect, Scopus, WebMD, EMBASE, and authorized textbooks to find relevant topics by means of Medical Subject Headings keywords such as "xerostomia," "hyposalivations," "mouth dryness," "disease," and "systemic." We appraised 97 English-language articles published over the last 40 years in both medical and dental journals including reviews, meta-analysis, original papers, and case reports. Upon compilation of relevant data, it was concluded that autoimmune diseases most frequently involve salivary glands and cause xerostomia followed by diabetes mellitus, renal failure, and graft-versus-host disease. Moreover, the underlying mechanisms of systemic disease-related xerostomia are: autoimmunity, infiltration of immunocompetent cells, granuloma formation, fibrosis and dehydration, deposition of proteinaceous substances, bacterial infection, and side-effects of medications.
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Affiliation(s)
- H Mortazavi
- Department of Oral and Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Baharvand
- Department of Oral and Maxillofacial Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Movahhedian
- Dental Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mohammadi
- Dental Student, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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TINÓS AMFG, SALES-PERES SHDC. Xerostomia related to HIV infection /AIDS: a critical review. REVISTA DE ODONTOLOGIA DA UNESP 2014. [DOI: 10.1590/rou.2014.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The presence of oral manifestations in HIV positive individuals is quite common. Xerostomia appears as one of the most frequent problems and may lead to a reduction in the quality of life of this population. Objective: This study was a critical review of the relationship between xerostomia and HIV infection, to attract the attention of dentists on the importance of dental care to these patients. Material and method: We included articles published between 2000 and 2009, indexed in PUBMED database. The descriptors used were "HIV" and "xerostomia", the exclusion criteria adopted were: the absence of these descriptors associated, non-location of the full-text, articles based on case studies or case series and the absence of the abstract in the database. Result: Based on studies in the review, it can be said that the xerostomia is a common manifestation of HIV infection, predisposing the patient to several other oral problems. Among the risk factors for its occurrence it was reported: low counts of CD4+ T cells, high plasma viral load, the use of some medications and antiretroviral therapy. Conclusion: The HIV/AIDS can change the salivary glands, and were considered important risk factors for the occurrence of xerostomia the presence of didanosine and the drug class which corresponds to protease inhibitors in antiretroviral therapy.
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Sharma S, Puri KJPS, Gambhir ML. Male preponderance in HIV seropositive patients with mucocutaneous complaints in a tertiary care hospital in North India. Asian Pac J Trop Biomed 2014; 4:S186-8. [DOI: 10.12980/apjtb.4.2014c1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022] Open
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Dongo M, Gonçalves LS, Ferreira SMS, Noce CW, Dias EP, Júnior AS. Gender differences in oral manifestations among HIV-infected Brazilian adults. Int Dent J 2013; 63:189-95. [PMID: 23879254 DOI: 10.1111/idj.12029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM The purpose of this study was to compare gender differences in the prevalence of oral lesions in HIV-infected Brazilian adults. METHODOLOGY A retrospective study was conducted of medical records from HIV/AIDS patients from 1993 to 2004. Oral lesions were only included in this study if definitively diagnosed through microscopic analysis, therapeutic test or according to EC-Clearing house criteria. RESULTS A total of 750 men and 237 women were included in the study. Statistically significant differences were observed only for oral hairy leukoplakia, Kaposi sarcoma and lymphadenopathy (P < 0.01). However, a model of logistic regression showed that only oral hairy leukoplakia presented a significant association with gender and males had a significantly likelihood (four times higher than females) of presenting with this oral manifestation [OR 4.3 (95% CI: 1.39-13.36)]. CONCLUSION These data shows that oral manifestations are less prevalent in females than in males, particularly oral hairy leukoplakia.
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Affiliation(s)
- Maria Dongo
- Medical School, Fluminense Federal University, Niteroi, Brazil
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Chattopadhyay A, Patton LL. Smoking as a risk factor for oral candidiasis in HIV-infected adults. J Oral Pathol Med 2012. [PMID: 23206208 DOI: 10.1111/jop.12019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to examine if smoking is an independent predictor of oral candidiasis (OC) among HIV-1 infected persons. METHODS The cross-sectional part of this study evaluated 631 adult dentate HIV-1 seropositive persons examined for OC from 1995-2000 at the University of North Carolina Hospitals in Chapel Hill, NC. In the second part, from the above sample, a total of 283 individuals who were free of HIV-associated oral diseases at baseline were followed up for 2 years to assess incident OC events. Data collected from medical record review, interview questionnaires, and clinical examinations were analyzed using chi-squared tests and t-tests. Logistic regression models were developed for prevalent OC employing the likelihood ratio test, whereas Poisson regression models were developed for assessing cumulative incidence of OC. These models included a variety of independent variables to adjust for confounding. RESULTS Thirteen percent of participants had OC only; 4.6% had OC with Oral Hairy Leukoplakia; and 69.7% had neither. Smoking was associated with OC in all models [prevalent OC - current smokers: logistic regression - Odd ratio (95% CI) = 2.5 (1.3, 4.8); Incident OC - current smokers: Poisson regression (main effects model) - Incidence rate ratio (95% CI) = 1.9 (1.1, 3.8)]. Other Poisson regression models suggested evidence for effect modification between CD4 cell count and incident OC by smoking. CONCLUSION Smoking is an independent risk factor for the development of OC in HIV-1 infected persons, and the risk of OC is modified by CD4 cell count which measures strength of the immune system.
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Busato IMS, Thomaz M, Toda AI, Alanis DGP, França BHS, de Lima AAS, Azevedo-Alanis LR. Prevalence and impact of xerostomia on the quality of life of people living with HIV/AIDS from Brazil. SPECIAL CARE IN DENTISTRY 2012; 33:128-32. [PMID: 23600984 DOI: 10.1111/j.1754-4505.2012.00290.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the impact of xerostomia on the quality of life (QOL) of people living with HIV/AIDS (PLWHA) from Brazil. STUDY DESIGN A cross-sectional study was performed on 195 PLWHA. Xerostomia was detected by asking a question about the sensation of having "dry mouth," and Oral Health Impact Profile 14 (OHIP-14) was used to measure the impact of xerostomia on QOL. Time of diagnosis of HIV/AIDS was assessed. RESULTS A total of 78 (40.0%) subjects presented with xerostomia. Xerostomia was associated with female gender, low amount of saliva perceived (p ≤ .01), difficulty in swallowing food (p ≤ .05), and showed to have a negative impact on QOL as measured by OHIP-14 (p ≤ .01). CONCLUSION Xerostomia was frequent and showed to have a negative impact on the QOL of PLWHA.
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Affiliation(s)
- Ivana Maria Saes Busato
- Graduate Program in Dentistry, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Annapurna CS, Prince CN, Sivaraj S, Ali IM. Oral manifestations of HIV patients in South Indian population. J Pharm Bioallied Sci 2012; 4:S364-8. [PMID: 23066291 PMCID: PMC3467899 DOI: 10.4103/0975-7406.100272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 01/02/2012] [Accepted: 01/26/2012] [Indexed: 11/29/2022] Open
Abstract
Objectives: To study the prevalence of oral manifestations in HIV-infected patients and to correlate oral manifestations with age, gender, severity, and clinical staging. Materials and Methods: Fifty patients of either sex diagnosed as HIV positive were included in the study. The data obtained were analyzed statistically using Fisher's exact test and Chi-square test. Results: Among the 50 HIV-infected patients, oral manifestations were found in 40 (80.0%) patients. Thirty (60%) patients were seen in the age range between 31 and 65 years, and 29 (58%) patients were females. Majority of the patients [26 (52%)] were in the clinical staging C, of whom 23 (88.5%) were with manifestations with significant statistical value (P < 0.05). Patients with CD4 count less than 200 had manifestations in 22 (88%) patients. Correlation between reduction in CD4 count and presence of manifestations was significant (P < 0.05). Twenty-eight (80%) patients without antiretroviral therapy (ART) reported with manifestations. Correlation between ART and presence of manifestations was not significant (P = 1.00). Interpretation and Conclusion: Oral manifestations are the indicators for the disease progression. Clinical stage C and lower CD4 count may be useful predictors for HIV, with greater prevalence of oral manifestations.
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Ponnam SR, Srivastava G, Theruru K. Oral manifestations of human immunodeficiency virus in children: An institutional study at highly active antiretroviral therapy centre in India. J Oral Maxillofac Pathol 2012; 16:195-202. [PMID: 22923890 PMCID: PMC3424934 DOI: 10.4103/0973-029x.98499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CONTEXT More than 1000 children are newly infected with Human immunodefi ciency virus (HIV) every day, and of these more than half will die as a result of AIDS due to lack of access to HIV treatment. HIV disease varies considerably in children. Among those infected prenatally, some experience few or no symptoms for years, whereas in others the disease progresses rapidly. The risk factors that influence the development of such oral manifestations include, low CD4+ T cell count, xerostomia and lack of highly active antiretroviral therapy (HAART). AIMS To identify the oral manifestations of HIV in children receiving HAART. MATERIALS AND METHODS The study comprised 95 children receiving HAART. 95 HIV +ve children not receiving HAART and 95 HIV -ve children were also included for comparing the manifestations of HIV. STATISTICAL ANALYSIS USED Statistical analysis was done using Fisher's Chi-square test. Probability value (P value) was obtained for the three groups. RESULTS The manifestations of HIV that were observed in children receiving HAART include dental caries (26%), periodontal diseases (23%), candidiasis (19%), hyperpigmentation (17%), ulcerative stomatitis (9%) and one case of mucocele. These manifestations were compared with HIV +ve children not receiving HAART and HIV -ve children to find manifestations with statistical significance. CONCLUSIONS We conclude that HAART had increased the disease-free states in HIV +ve children on HAART promising them better life span. The incidence of oral lesions can further come down with adequate oral hygiene measures in HIV-infected children.
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Affiliation(s)
- Srinivas Rao Ponnam
- Department of Oral Pathology, Government Dental College and Hospital, Gunadala, Vijayawada, Andhra Pradesh, India
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Li X, Lei L, Tan D, Jiang L, Zeng X, Dan H, Liao G, Chen Q. Oropharyngeal Candida colonization in human immunodeficiency virus infected patients. APMIS 2012; 121:375-402. [PMID: 23030258 DOI: 10.1111/apm.12006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 08/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaoxu Li
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Lei Lei
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Dan Tan
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Ga Liao
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases; West China College of Stomatology; Sichuan University; Chengdu; China
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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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Oral Candidiasis: Aiding in the Diagnosis of HIV-A Case Report. Case Rep Dent 2011; 2011:929616. [PMID: 22567448 PMCID: PMC3335721 DOI: 10.1155/2011/929616] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 07/17/2011] [Indexed: 11/17/2022] Open
Abstract
Opportunistic fungal infections account for a significant amount of morbidity associated with HIV disease. Candidiasis is the most common oral opportunistic infection affecting people with HIV infection or AIDS. It is considered as an important marker of immune suppression and may be the initial manifestation of the disease in about 10% of HIV-infected adults. We report a case of an apparently healthy 45-year-old male with oral candidiasis which proved to be the first indicator of HIV infection.
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Bodhade AS, Ganvir SM, Hazarey VK. Oral manifestations of HIV infection and their correlation with CD4 count. J Oral Sci 2011; 53:203-11. [PMID: 21712625 DOI: 10.2334/josnusd.53.203] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Human Immunodeficiency Virus (HIV)-related oral lesions can be used as markers of the immune status. The present cross-sectional study was conducted to identify the oral manifestations in HIV-infected individuals and their association with reduced Cluster of Differentiation 4 (CD4) count. The study population included known HIV-positive patients. A detailed case history of 399 HIV-positive patients was obtained and general examination was carried out. Diagnosis of oral lesions was done based on presumptive criteria of EEC Clearinghouse, 1993. The CD4 count was determined in 369 patients and correlated with oral manifestations. The prevalence of oral lesions was found to be 76.70% (n = 306). Oral candidiasis (157 (39.3%)) was the most common oral lesion associated with HIV infection. Amongst various forms of oral candidiasis, erythematous candidiasis (122 (39.3%)) outnumbered the other forms. The mean CD4 count of patients with oral lesions (207 cells/mm(3)) was less than in patients without oral lesions (291 cells/mm(3)) (P = 0.002). Oral candidiasis was found to be significantly correlated to a reduced CD4 cell count below 200 cells/mm(3) (P = 0.000; Odds ratio = 3.1; 95% Confidence interval 1.9-4.9) with good sensitivity, best specificity and positive predictive value. Oral manifestations may be used as an alternative to CD4 count at field-based settings to diagnose the immune compromised status of HIV-infected individuals.
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Affiliation(s)
- Ashish S Bodhade
- Department of Oral and Maxillofacial Pathology, VSPM'S Dental College and Research Center, Nagpur, Maharashtra, India.
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Tessarolli V, Gasparoto TH, Lima HR, Figueira EA, Garlet TP, Torres SA, Garlet GP, Da Silva JS, Campanelli AP. Absence of TLR2 influences survival of neutrophils after infection with Candida albicans. Med Mycol 2010; 48:129-40. [PMID: 19468929 DOI: 10.3109/13693780902964339] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Candida albicans is an opportunistic pathogen, which causes local and/or disseminated diseases in immunosuppressed humans. Phagocytic cells play a critical role in the immune response against C. albicans. Toll like receptors (TLR) are important in the identification of invading microorganisms and in the regulation of neutrophil survival. TLR2 has been shown to participate in the response against pathogenic yeasts and to increase the functional life span of neutrophils. In view of these observations, we studied the involvement of TLR2 in neutrophil function after C. albicans infection. The absence of TLR2 resulted in lower chemotaxis of neutrophils to the site of infection. This in turn was associated with lower levels of chemokines from neutrophils, facilitating the dissemination of the pathogen to the lymph nodes and spleen. A high frequency of apoptotic neutrophils and macrophages in the inflammatory exudates from TLR2(-/-) mice was found. In addition, the phagocytic activity of neutrophils and macrophages, nitric oxide production and myeloperoxidase activity were diminished in cells from TLR2(-/-) mice. Together, these data demonstrate the importance of TLR2 signals for neutrophils activation and survival after C. albicans infection.
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Affiliation(s)
- Venessa Tessarolli
- Department of Biological Sciences, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
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Nittayananta W, Talungchit S, Jaruratanasirikul S, Silpapojakul K, Chayakul P, Nilmanat A, Pruphetkaew N. Effects of long-term use of HAART on oral health status of HIV-infected subjects. J Oral Pathol Med 2010; 39:397-406. [PMID: 20202089 DOI: 10.1111/j.1600-0714.2009.00875.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to determine the effects of long-term use of highly active antiretroviral therapy (HAART) on oral health status of HIV-infected subjects. METHODS Oral examination and measurement of saliva flow rate of both unstimulated and wax-stimulated whole saliva were performed in HIV-infected subjects with and without HAART, and in non-HIV individuals. The following data were recorded; duration and risk of HIV infection, type and duration of HAART, CD4 cell count, viral load, presence of orofacial pain, oral dryness, oral burning sensation, oral lesions, cervical caries, and periodontal pocket. Multiple logistic regression analysis was performed to determine the effects of long-term use of HAART on oral health status of HIV-infected subjects. RESULTS One hundred and fifty-seven HIV-infected subjects - 99 on HAART (age range 23-57 years, mean 39 years) and 58 not on HAART (age range 20-59 years, mean 34 years) - and 50 non-HIV controls (age range 19-59 years, mean 36 years) were enrolled. The most common HAART regimen was 2 NRTI + 2 NNRTI. HIV-infected subjects without HAART showed greater risks of having orofacial pain, oral dryness, oral lesions, and periodontal pockets than those with short-term HAART (P < 0.01). The subjects with long-term HAART were found to have a greater risk of having oral lesions than those with short-term HAART (P < 0.05). The unstimulated and stimulated salivary flow rates of the subjects with HAART were significantly lower than in those without HAART (P < 0.05). CONCLUSION We conclude that long-term HAART has adverse effects on oral health status of HIV-infected subjects.
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Affiliation(s)
- Wipawee Nittayananta
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
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Abstract
PURPOSE The purpose of this study is to review the Chinese-language medical and dental literature from 1982 to 2008 on oral manifestations (OMs) of patients with HIV/AIDS for introducing the spectrum of OMs of the patients in China. MATERIALS AND METHODS All data were extracted from 18 references which had used diagnostic criteria for HIV/AIDS. Four of the references had used the EC-Clearinghouse classification for oral lesions in HIV infection. The feasible overall rate and 95% confidence interval (95%CI) of the data on OMs were calculated. RESULTS Risk group analysis revealed that, of 203 patients, 64.3% were men and 35.7% were women (age range, 5 months to 64 years; mean age in three studies, 34.0, 34.3, and 36.1 years). Of these patients, 22.2% were infected by sexual contacts, 11.8% by intravenous drug use (IDU), 59.6% by blood or its products, 2.9% by mother to child transmission, and 3.4% were unclear. In 203 patients, oral candidiasis (OC) was the most common lesion (66%, 95%CI = 59.48-72.52%), followed by herpes simplex (HS) (22.2%, 95%CI = 16.48-27.92%), ulcerative stomatitis (14.8%, 95%CI = 9.92-19.68%), salivary gland disease (11.3%, 95%CI = 6.94-15.66%), oral hairy leukoplakia (OHL) (9.8%, 95%CI = 5.71-13.89%), necrotizing gingivitis (5.9%, 95%CI = 2.66-9.14%), Kaposi's sarcoma (2.9%, 95%CI = 0.59-5.21%), other malignant tumors (2.9%, 95%CI = 0.59-5.21%), and linear gingival erythema (2.0%, 95%CI = 0.07-3.93%). CONCLUSIONS The spectrum of OMs reported from China is similar to that described in the international literature. Present data are useful to supplement international resources of HIV/AIDS research.
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Affiliation(s)
- Xiaolin Zhang
- Department of Oral Biology, School and Hospital of Stomatology, Peking University, Zhongguancun Nandajie 22, Beijing, 100081, People's Republic of China.
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Gabler IG, Barbosa AC, Velela RR, Lyon S, Rosa CA. Incidence and anatomic localization of oral candidiasis in patients with AIDS hospitalized in a public hospital in Belo Horizonte, MG, Brazil. J Appl Oral Sci 2009; 16:247-50. [PMID: 19089255 PMCID: PMC4327532 DOI: 10.1590/s1678-77572008000400004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/29/2008] [Indexed: 01/02/2023] Open
Abstract
The objective of this study was to evaluate the incidence, anatomic localization and yeast species isolated from each clinical type of oral candidiasis. The clinical samples were obtained from 67 patients with AIDS with CD4 cell counts below 200 cells/mm3 and hospitalized in a public hospital (Eduardo de Menezes Hospital) in the city of Belo Horizonte, MG, Brazil. Yeasts were isolated using Chromagar® Candida. The results show that 50.7% of these patients had oral candidiasis. The pseudomembranous form was the most frequent clinical manifestation of oral candidiasis, followed by the erythematous and angular cheilite forms. The most common site of these clinical forms of oral candidiasis was the tongue. Candida albicans was the most common yeast species isolated from the lesions. However, other species were also found to be associated with these forms of oral candidiasis.
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Affiliation(s)
- Ilanna G Gabler
- Department of Microbiology, Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Ghate M, Deshpande S, Tripathy S, Nene M, Gedam P, Godbole S, Thakar M, Risbud A, Bollinger R, Mehendale S. Incidence of common opportunistic infections in HIV-infected individuals in Pune, India: analysis by stages of immunosuppression represented by CD4 counts. Int J Infect Dis 2008; 13:e1-8. [PMID: 18602329 DOI: 10.1016/j.ijid.2008.03.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 01/08/2008] [Accepted: 03/26/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Opportunistic infections (OIs) influence the morbidity and mortality due to HIV infections. Data from India on the incidence of OIs among HIV-infected individuals by stages of immunodeficiency are scarce. METHODS Between September 2002 and November 2004, HIV-infected individuals were enrolled in a prospective study in Pune. They were clinically and immunologically evaluated quarterly. Incidence rates of specific OIs were calculated. RESULTS Median CD4 counts in HIV-infected male and female patients at baseline were 197/mm(3) and 413/mm(3), respectively. Tuberculosis was the most common OI with an incidence of 15.4 (95% CI 12.2-19.2) per 100 person-years, followed by oral candidiasis 11.3 (95% CI 8.6-14.5), herpes zoster 10.1 (95% CI 7.6-13.1), and cryptococcal meningitis 1.7 (95% CI 0.8-3.1) per 100 person-years. Patients with baseline CD4 counts of <200/mm(3) were six times more likely to develop OIs compared to those with CD4 counts of >350/mm(3) (p<0.001). CONCLUSIONS The high incidence of commonly reported OIs in Indian HIV-infected individuals highlights the need for early screening and also the need to increase awareness in healthcare providers, in order to improve decisions regarding prophylaxis for prevention and appropriate therapeutic intervention. Emphasis needs to be given to the early diagnosis and management of tuberculosis in HIV-infected individuals.
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Girish Kumar CP, Menon T, Rajasekaran S, Sekar B, Prabu D. Carriage of Candida species in oral cavities of HIV infected patients in South India. Mycoses 2008; 52:44-8. [PMID: 18522700 DOI: 10.1111/j.1439-0507.2008.01534.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fifty-four patients with human immunodeficiency virus (HIV) infection were studied to assess the load of oral carriage of Candida spp. The mean oral Candida carriage density (30,305.93 +/- 56,643.93 CFU ml(-1)) in HIV patients was significantly higher than that seen in the control population (93.48 +/- 358.48 CFU ml(-1); P = 0.000). The mean Candida load in HIV patients with oral thrush (46,591.43 +/- 65,002.57 CFU ml(-1)) was significantly higher than in the HIV subjects without oral thrush (306.32 +/- 699.50 CFU ml(-1); P = 0.000). Non-C. albicans Candida species (56%) were more predominant than the C. albicans (44%) isolates. 25S rDNA PCR analysis of C. albicans revealed preponderance of genotype A strains. Interestingly, 42.6% of rinse specimens grew multiple Candida species, with the combination of C. albicans and C. krusei (39.1%) being the most frequent.
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Affiliation(s)
- C P Girish Kumar
- Department of Microbiology, Dr A. L. Mudaliar Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India
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Hegarty AM, Chaudhry SI, Hodgson TA. Oral healthcare for HIV-infected patients: an international perspective. Expert Opin Pharmacother 2008; 9:387-404. [DOI: 10.1517/14656566.9.3.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Tirwomwe JF, Rwenyonyi CM, Muwazi LM, Besigye B, Mboli F. Oral manifestations of HIV/AIDS in clients attending TASO clinics in Uganda. Clin Oral Investig 2007; 11:289-92. [PMID: 17476537 DOI: 10.1007/s00784-007-0118-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 04/18/2007] [Indexed: 10/23/2022]
Abstract
The objective of the study is to establish the prevalence of oral manifestations and their influence on oral functions. A total of 514 subjects aged 18 to 58 years (mean 42 years) were randomly recruited from five The AIDS Support Organization (TASO) clinics in Uganda. They were clinically examined for oral lesions under field conditions by four trained dentists based on World Health Organization criteria. Women constituted 74.5% of the study population. Oral manifestations were recorded in 72% of the subjects, out of which 70% had candidiasis of pseudomembranous, erythematous, and angular cheilitis variants. Non-Hodgkin's lymphoma, atypical ulcers, necrotizing periodontitis, and hairy leucoplakia were least frequently observed in the subjects. Of those who had oral lesions (n = 370), 68.4% had some form of discomfort in the mouth. Tooth brushing, chewing, and swallowing were frequently associated with discomfort. Reported forms of discomfort were dry mouth, increased salivation, and burning sensation especially on taking salty and spicy foods or acidic drinks. Only 8.5% (n = 44) of the subjects were taking medications specifically for oral lesions, which included antifungal, antiviral, and antibacterial agents. None of the subjects were on antiretroviral therapy. Oral lesions associated with human immunodeficiency virus/acquired immunodeficiency syndrome in TASO clients is a major public health problem requiring education in recognition and appropriate management.
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Affiliation(s)
- J F Tirwomwe
- Department of Dentistry, School of Health Sciences, Kampala International University, Kampala, Uganda
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