Patterns of oral manifestation of HIV/AIDS among 225 Nigerian patients

"Oral manifestations of HIV in accordance with CD4 count" - A cross-sectional study

Aims and Objectives

Mouth acts as a mirror for most of the underlying systemic diseases. Very few studies were done in south Indian population to observe the oral manifestations of human immunodeficiency virus (HIV) in relation to the cluster of differentiation 4 (CD4) count, and this study mainly highlights the presenting complaint of HIV patients during their dental visit. The study was aimed to determine the chief complaints of patients along with oral manifestations of HIV and correlate them to CD4 count.

Materials and Methods

One hundred consecutive HIV-positive patients were considered for the study. All the oral manifestations and the chief complaints along with the calculated CD4 counts were noted and the results were correlated. Spearman correlation was used for CD4 count and other oral manifestations.

Results

The mean CD4 counts were 421 cells/mm³ with a standard deviation (SD) of 404.34 for the most common oral manifestation of burning mouth and 176.5 cells/mm³ for the least common manifestation of malignancies. The CD4 count ranged from 120 to 1100 cells/mm³. The mean age and CD4 count were 38 years and 398.86, respectively. There was a statistically significant correlation with candidiasis and gingivitis, and the rest of the conditions were insignificant.

Conclusion

The study results suggest that the chief complaint of presentation of an HIV-positive patient is pain due to carious teeth/abscess followed by burning mouth, with candidiasis being the most common disease.

Oro-facial opportunistic infections and related pathologies in HIV patients: A comprehensive review

Among all the viral infections, acquired immunodeficiency syndrome (AIDS) is considered as one of the most morbid infections caused by the human immunodeficiency virus (HIV). The prime reason for the pathogenesis is the profound immunosuppression that leads to lethal opportunistic infections (OI), neurological disorders, unexpected malignancies and pathologies of the orofacial region. Patients with OI whose HIV status is unknown have shown a mortality rate higher than those with known HIV status. Among HIV-associated infections, orofacial lesions contribute a major proportion of the OI attributed to the plethora of micro-organisms present in the oral cavity. Apart from serious clinical manifestations, opportunistic infections also lead to significant impairment of quality of life. These lesions not only indicate the HIV infection but also among the clinical manifestations, which often occur early in the course of disease. World Health Organization has also provided policies for treatment/prevention of oral lesions, strengthening the promotion and care of oral health in HIV/AIDS patients. The present review provides comprehensive information about orofacial OI in HIV/AIDS patients and emphasis was also given to the malignancies associated with EB and HTLV virus.

A real-world, cross sectional study of oral lesions and their association with CD4 cell counts and HIV viral load in Yunnan, China

Human immunodeficiency virus (HIV) supresses immune system, primarily cell-mediated immunity. Cluster of differentiation 4 (CD4) cell count, viral load, and oral lesions are the most important laboratory parameters to evaluate the evolution of acquired immunodeficiency syndrome. The present study aims to determine the incidence of HIV-related oral lesions with CD4 cell count and viral load in Yunnan, China.A cross-sectional study was conducted from December 2007 to December 2009, in 1812 HIV positive patients from Department of Infectious Diseases in Kunming Third People's Hospital. CD4, CD8, and viral load data were collected and analyzed statistically using SPSS 11.3.Out of 1812 HIV positive patients, 929 (51.27%) were associated with 1 or more oral lesions. The most common oral lesions observed were Candida Pseudomembranous (13.75%), Candida erythematous (10.93%), Oral hairy leukoplakia (7.95%), Aphthous ulcer (6.18%), Herpes simplex infection (5.58%). In most patients with oral lesions, the CD4 cell count was < 200/μL. The incidence of oral lesions was lower when CD4 count was > 200/μL and with undetectable (P < .01) HIV viral load. Almost no oral lesions was observed when CD4 count > 500/μL (P < .01). With highly active antiretroviral therapy, reduction in HIV-related oral lesions was observed especially in Candida erythematous, Candida Pseudomembranous, Oral hairy leukoplakia, and Aphthous ulcer.The higher incidence of oral lesions with lower CD4 count (<200/μL) in HIV-infected patients indicated importance of CD4 cell count in identifying disease progression.

Oropharyngeal candidiasis in HIV/AIDS patients and non-HIV subjects in the Southeast of Iran

BACKGROUND AND PURPOSE

Candida species are the common opportunistic pathogens during the course of human immunodeficiency virus (HIV) infection. Oropharyngeal candidiasis (OPC) is generally known as the initial sign of HIV infection. The aim of this study was to compare demographic characteristics and frequency of Candida species between HIV/AIDS patients and non-HIV subjects in Kerman, southeast of Iran.

MATERIALS AND METHODS

This study was conducted on 143 samples collected from the oral cavity of 81 HIV/AIDS patients and 35 non-HIV subjects. The samples were cultured on Sabouraud dextrose agar and CHROMagar. The identification of Candida species was accomplished using the color of colony and polymerase chain reaction-restriction fragment length polymorphism.

RESULTS

According to the results, C. albicans (n=25, 69.14%) was the most prevalent species isolated from the HIV/AIDS patients, followed by C. glabrata (n=19, 23.46%). Other isolated species included C. parapsilosis (n=4, 4.94 %), C. krusei (n=1, 1.24%), and C. kefyr (n=1, 1.24%). Out of the 35 Candida species recovered from the oral samples of non-HIV subjects, 23 (65.71%) and 12 (34.29%) cases were C. krusei and C. albicans, respectively. Candida krusei was the only non-albicans species found in the non-HIV subjects that was also the predominant isolated species. Regarding the HIV/AIDS patients, the highest prevalence of OPC was observed in the age group of 41-50 years. However, in the non-HIV subjects, the age group of 31-40 years had the highest prevalence of this infection. Furthermore, no correlation was observed between the gender and number of Candida isolates.

CONCLUSION

Consideration of the epidemiologic data showed that the two groups were significantly different in terms of the prevalence of Candida species, which could play a major role in the selection of effective drugs for the treatment of candidiasis.

Systematic review of the changing pattern of the oral manifestations of HIV

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.

Oropharyngeal Candidosis in HIV-Infected Patients-An Update

Oropharyngeal candidosis (OPC) is an opportunistic fungal infection that is commonly found in HIV-infected patients, even in the twenty-first century. Candida albicans is the main pathogen, but other Candida species have been isolated. OPC usually presents months or years before other severe opportunistic infections and may indicate the presence or progression of HIV disease. The concept of OPC as a biofilm infection has changed our understanding of its pathobiology. Various anti-fungal agents (both topical and systemic) are available to treat OPC. However, anti-fungal resistance as a result of the long-term use of anti-fungal agents and recurrent oropharyngeal infection in AIDS patients require alternative anti-fungal therapies. In addition, both identifying the causative Candida species and conducting anti-fungal vulnerability testing can improve a clinician's ability to prescribe effective anti-fungal agents. The present review focuses on the current findings and therapeutic challenges for HIV-infected patients with OPC.

Oral manifestations and their correlation to baseline CD4 count of HIV/AIDS patients in Ghana

Objectives

Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana.

Materials and Methods

A total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance.

Results

Our study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions.

Conclusion

From a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.

Dental and Oral Lesions in HIV-Positive Individuals in East Bohemia--Czech Republic, Single Centre Experience

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.

Management algorithm for HIV-associated parotid lymphoepithelial cysts

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.

Oral health management of 97 patients living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

Frequency, pattern, and extent of skin diseases in relation to CD4+ cell count among adults with human immunodeficiency virus infection or acquired immunodeficiency syndrome in Osogbo, southwestern Nigeria

BACKGROUND

Skin diseases characterize all stages of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and contribute significantly to associated morbidity and mortality.

OBJECTIVES

The aim of this study was to document the prevalences, patterns, and extents (severity) of skin diseases and their relationships with immunologic status in HIV/AIDS patients.

METHODS

A total of 140 HIV/AIDS patients in different stages of HIV infection and 140 controls were recruited. Skin diseases were documented and CD4+ cell counts determined in all subjects. Severity was assessed according to the body surface area affected (using the Wallace rule of nines and the rule of palm) for lesions that tended to be widespread. The number of digits involved was counted for lesions involving the nails. Intensity of pain was graded for specific conditions such as herpes zoster. Chi-squared statistics and Pearson correlations were determined.

RESULTS

Mean±standard deviation age was 35.04±8.83 years in the patient group and 32.21±8.30 years in the control group. The prevalences and patterns of skin diseases in HIV/AIDS patients were similar to those reported in previous studies. Most commonly found dermatoses were oral candidiasis (n=28, 20.0%), pruritic papular eruption (n=27, 19.3%), xeroderma (n=23, 16.4%), dermatophytosis (n=22, 15.7%), and fluffy hair (n=19, 13.6%). The presence of specific skin lesions represented a better correlate with immunosuppression than cutaneous extents. However, the extents of viral warts and multiple blue–black nails correlated significantly with CD4+ cell count. The presence of a lighter hair color phenotype signifies a lower CD4+ cell count than a softer hair phenotype.

CONCLUSIONS

The presence of specific skin lesions correlates more strongly with a low CD4+ cell count than does the extent of their distribution, except in cases of viral warts. The presence of and higher numbers of nails affected with blue–black nail hyperpigmentation suggest severe immunosuppression.

Prevalence of Oral Manifestations and Their Association with CD4/CD8 Ratio and HIV Viral Load in South India

The objective of the present research was to determine the prevalence of oral manifestations in an HIV infected population from south India and evaluate their association with HIV viral load and CD4/CD8 ratio. Intraoral examination of 103 patients, whose CD4/CD8 ratio was available, were conducted. HIV viral loads were available for thirty patients only. The prevalence of oral manifestations was 80.6% (83/103). The most common oromucosal lesion was erythematous candidiasis (EC) (38.8%) followed by melanotic hyperpigmentation (35.9%). Patients having any oral manifestation had a mean CD4/CD8 ratio of 0.24. EC had positive predictive value of 85.0% for CD4/CD8 ratio <0.30. The prevalence of oral manifestations in patients taking ART was lesser (78.6%) as compared to patients not taking ART (82%). Patients having any oral manifestation had a higher HIV viral load as compared to patients not having any oral manifestations (P < 0.05). Pseudomembranous candidiasis (PC) was significantly associated with higher HIV viral loads (>20,000 copies/mL) (P < 0.05). Patients having EC had 4 times greater chance of having CD4/CD8 ratio <0.30. PC can be considered as a marker of immune suppression (HIV viral load >20,000 copies/mL).

The Alma-Ata declaration: an appraisal of Nigeria's primary oral health care three decades later

AIM

This work is a critical appraisal of the state of primary oral health care in Nigeria, the largest Black nation on earth, three decades after the Alma-Ata declaration of primary health care.

METHODS

A review based on published peer-reviewed journals, documents from international organs like the World Health Organization, internet sources and newspapers, which beams a searchlight on the state of health care in Nigeria.

RESULTS

Results show a lot of decay in the primary health care sector and a lack of proper amalgamation defined by affirmative action of the primary oral health care into the mainstream of primary health care.

CONCLUSION

Time for massive action, first by the government, and then by the oral health professionals and the public and all stake-holders to ensure that the dream of Alma-Ata does not remain an illusion in Nigeria's oral health care sector.

Oral Manifestations Related To CD4 Lymphocyte Count in HIV-Positive Patients

Background and aims

The onset of opportunistic infections in HIV-positive patients is generally associated with a low CD4 count. Oral manifestations can be the first clinical sign of the infection and also determine the progression of disease. The purpose of this study was to determine the prevalence of oral soft tissue manifestations and their relationship with the degree of immunosuppression observed in HIV-positive patients.

Materials and methods

100 HIV-positive patients were examined. Oral lesions were evaluated according to EEC clearing house criteria. The degree of immunosuppression was based on the CD4 count closest to the oral examination. Data were analyzed using Student’s t-test and chi-square test.

Results

The most common oral lesions were rampant caries (54%), periodontal disease (44%), and hyperpigmentation (42%). Salivary glands enlargements and leukoplakia were associated with more severe immunosuppression.

Conclusion

According to the results, it seems that occurrence of only some of oral lesions are related to the degree of immunosuppression and such lesions can be considered as indicators of the progression of the HIV infection.

HIV-associated salivary gland disease

The authors review the clinical presentation, diagnostic evaluation, and treatment modalities for salivary gland enlargement in an HIV-infected population. Because this can occasionally be the presenting clinical symptom of HIV infection, it is important for the oral/maxillofacial surgeon to diagnose and manage HIV salivary gland enlargement.