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Kumar K, Subramaniam P, Prakash AJ. HAART medication and oral health status in children and adolescent HIV infected: A case control study. SPECIAL CARE IN DENTISTRY 2024; 44:919-924. [PMID: 37984407 DOI: 10.1111/scd.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/17/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The advent of Highly Active Anti-Retroviral Therapy (HAART) does influence the overall oral health care of children. The children undergoing HAART have shown an increase in caries activity owing to sugars in medicines to make them more palatable. AIM The aim of the study was to assess and compare the Oral Health of Children Living with HIV/AIDS (CLHAs) and Adolescents Living with HIV/AIDS (ALHAs) undergoing HAART and those who are HAART-naïve. METHODS This study was carried out at different Non-Governmental Organizations (NGO's) across Kerala, India. The study group consisted of 150 HIV-infected children aged 6-18 years. They were divided into two groups. Group 1 comprised of children prior to onset of HAART and Group 2 included children who had been on HAART for more than 3 years (HAART naïve). The assessment of dental caries status and dental plaque status was done. The observations were tabulated and statistically analyzed. RESULTS On Statistical Analysis, significant difference was noted between the groups with the Group 1(2.26 ± 0.58;p value = .000*) showing higher scores of dental plaque and a significant difference was also observed with respect to dental caries scores with DMFT and dmft scores higher in Group 2(dmft 2.08 ± 2.85; p value = .001* and DMFT 4.10 ± 1.71;p value = .003*). CONCLUSION It was concluded that oral hygiene conditions were poor in children with HIV, with dental plaque scores more in HAART-naïve which may be due to their lesser visits and reinforcements regarding oral hygiene from a dentist and dental caries score more in HAART group, this may be attributed to the hidden sugars present in HAART medications to make it more palatable. Early recognition and management of oral conditions are important to improve the quality of life for these children.
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Affiliation(s)
- Krishna Kumar
- Department of Pediatrics and Preventive Dentistry, Annoor Dental College and Hospital, Muvattupuzha, Kerala, India
| | - Priya Subramaniam
- Head of Department, Department of Pediatrics and Preventive Dentistry, The Oxford Dental College and Hospital, Bengaluru, Karnataka, India
| | - Aarathi J Prakash
- Department of Pediatrics and Preventive Dentistry, Department of Pediatrics and Preventive Dentistry, Malabar Dental College and Research Center, Edappal, Kerala, India
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Seminario AL, Kemoli A, Fuentes W, Wang Y, Rajanbabu P, Wamalwa D, Benki-Nugent S, John-Stewart G, Slyker JA. The effect of antiretroviral therapy initiation on vitamin D levels and four oral diseases among Kenyan children and adolescents living with HIV. PLoS One 2022; 17:e0275663. [PMID: 36227876 PMCID: PMC9560522 DOI: 10.1371/journal.pone.0275663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The impact of antiretroviral treatment (ART) on the occurrence of oral diseases among children and adolescents living with HIV (CALHIV) is poorly understood. The aim of this study was to determine the effect of ART timing on vitamin D levels and the prevalence of four oral diseases (dry mouth, dental caries, enamel hypoplasia, and non-herpes oral ulcer) among Kenyan CALHIV from two pediatric HIV cohorts. METHODS This nested cross-sectional study was conducted at the Kenyatta National Hospital, Nairobi, Kenya. CALHIV, 51 with early-ART initiated at <12 months of age and 27 with late-ART initiated between 18 months-12 years of age, were included. Demographics, HIV diagnosis, baseline CD4 and HIV RNA viral load data were extracted from the primary study databases. Community Oral Health Officers performed oral health examinations following standardized training. RESULTS Among 78 CALHIV in the study, median age at the time of the oral examination was 11.4 years old and median ART duration at the time of oral examination was 11 years (IQR: 10.1, 13.4). Mean serum vitamin D level was significantly higher among the early-ART group than the late-ART group (29.5 versus 22.4 ng/mL, p = 0.0002). Children who received early-ART had a 70% reduction in risk of inadequate vitamin D level (<20 ng/mL), compared to those who received late-ART (p = 0.02). Although both groups had similar prevalence of oral diseases overall (early-ART 82.4%; late-ART 85.2%; p = 0.2), there was a trend for higher prevalence of dry mouth (p = 0.1) and dental caries (p = 0.1) in the early versus late ART groups. The prevalence of the four oral diseases was not associated with vitamin D levels (p = 0.583). CONCLUSIONS After >10 years of ART, CALHIV with early-ART initiation had higher serum vitamin D levels compared to the late-ART group. The four oral diseases were not significantly associated with timing of ART initiation or serum vitamin D concentrations in this cohort. There was a trend for higher prevalence of dry mouth and dental caries in the early-ART group, probably as side-effects of ART.
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Affiliation(s)
- Ana Lucia Seminario
- Department of Pediatric Dentistry, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Arthur Kemoli
- Department of Pediatric Dentistry & Orthodontics, University of Nairobi, Nairobi, Kenya
| | - Walter Fuentes
- Petaluma Health Center, University of California San Francisco, Petaluma, California, United States of America
| | - Yan Wang
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Poojashree Rajanbabu
- University of Washington Timothy A. DeRouen Center for Global Oral Health, Seattle, Washington, United States of America
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Sarah Benki-Nugent
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics and Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Jennifer A. Slyker
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
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Akhigbe P, Chukwumah NM, Folayan MO, Divaris K, Obuekwe O, Omoigberale A, Jedy-Agba E, Kim M, Charurat ME, Richards VP, Coker MO. Age-specific associations with dental caries in HIV-infected, exposed but uninfected and HIV-unexposed uninfected children in Nigeria. BMC Oral Health 2022; 22:429. [PMID: 36167498 PMCID: PMC9512979 DOI: 10.1186/s12903-022-02421-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background HIV infection and its management confer a substantial health burden to affected individuals and have been associated with increased risk of oral and dental diseases. In this study, we sought to quantify HIV-associated differences in the prevalence and severity of dental caries in the primary and permanent dentition of 4–11-year-old Nigerian Children. Methods We used clinical, laboratory, demographic, and behavioral data obtained from an ongoing cohort study of age-matched HIV-infected (HI, n = 181), HIV-exposed-but-uninfected (HEU, n = 177), and HIV-unexposed-and-uninfected (HUU, n = 186) children. Measures of dental caries experience (i.e., prevalence and severity) were based on dmft/DMFT indices recorded by trained and calibrated clinical examiners. Differences in primary and permanent dentition caries experience between HI, HEU, and HUU were estimated using multivariable logistic and negative binomial regression modeling. Results HI children had significantly higher caries experience (33%) compared to HEU (15%) and HUU (22%) children. This difference persisted in fully adjusted analyses [odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.0–2.6], was most pronounced in the permanent dentition (OR = 3.4; 95% CI = 1.2–9.5), and mirrored differences in caries severity. While molars were predominantly affected in both primary and permanent dentitions, caries lesion patterns differed between dentitions. Caries severity was significantly associated with hypoplastic primary teeth, gingival inflammation, and lower CD4 counts. Conclusions We found that the higher prevalence and severity of dental caries among HI children was driven by increased burden of permanent dentition caries compared to their uninfected counterparts. The dentition-specific associations identified in this study highlight the need to design and implement age-specific caries prevention strategies. These may include intensified oral hygiene regimens aimed at mitigating the cariogenic impact of hyposalivation among HI children. Similarly, the long-lasting impacts of developmental defects of the enamel in the primary and permanent dentitions must not be ignored. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02421-w.
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Affiliation(s)
- Paul Akhigbe
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Nneka M Chukwumah
- Department of Preventive Dentistry, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Kimon Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Ozoemene Obuekwe
- Department of Preventive Dentistry, University of Benin Teaching Hospital, Benin, Edo State, Nigeria.,Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Augustine Omoigberale
- Department of Preventive Dentistry, University of Benin Teaching Hospital, Benin, Edo State, Nigeria.,Child Health Department, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Michael Kim
- Department of Oral Biology, School of Dental Medicine, Rutgers University, Newark, NJ, USA
| | - Manhattan E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MA, USA
| | | | - Modupe O Coker
- Department of Oral Biology, School of Dental Medicine, Rutgers University, Newark, NJ, USA. .,Department of Epidemiology, School of Public Health, Rutgers University, Newark, NJ, USA. .,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Mulder R, Mohamed N, Mathiba O. Prevalence of oral mucosal lesions in human immunodeficiency virus-infected children attending the Pediatric Infectious Diseases Clinic in Cape Town. Clin Exp Dent Res 2021; 8:160-168. [PMID: 34586712 PMCID: PMC8874076 DOI: 10.1002/cre2.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Investigation of the prevalence of oral mucosal lesions in human immunodeficiency virus (HIV)‐infected children undergoing highly active antiretroviral therapy (HAART). Materials and Methods Cross‐sectional study of 66 HIV seropositive children, comprised of 28 (42.4%) females and 38 (57.6%) males (average age of 6 years). Study participants all required data regarding CD4+ T‐helper cell counts and the viral load. All participants underwent an orofacial clinical examination by calibrated clinicians. Associations between the presence of oral mucosal lesions, CD4+ cell counts, and viral load were analyzed using Poisson regression. Results The prevalence of oral manifestations was detected in 21 children (31.8%). Oral lesions were detected in 16 children with viral load copies <50 cells/mm3 and 22 children with CD4+ counts >500 cells/mm3. Predominant lesions identified included angular cheilitis (36.7%), candidiasis (13.3%) and atypical oral ulcers (13.3%). The presence of one lesion was the most prevalent represented by 19 children. Oral lesions in relation to the CD4+ counts >500 resulted in; 14 children with one oral lesion, 5 with two lesions and 3 with three oral mucosal lesions. The other half of this CD4+ count patient group presented with no oral mucosal lesions. Oral lesions in relation Viral load copies <50 resulted in; 9 children with one oral lesion, 3 with two oral mucosal lesions and 4 with three oral mucosal lesions. The other half of this Viral load patient group presented with no oral mucosal lesions. No significant correlations were established between the presence of oral mucosal lesions and low CD4+ counts (p = 0.715) nor with high viral load counts (p = 0.638). Conclusion HIV‐related oral mucosal lesions still presented in the participants despite management with HAART. Based on the results, CD4+ counts and viral load does not appear to be suitable markers of orofacial involvement in children.
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Affiliation(s)
- Riaan Mulder
- Restorative DentistryThe University of the Western CapeCape TownSouth Africa
| | - Nadia Mohamed
- Pediatric DentistryThe University of the Western CapeCape TownSouth Africa
| | - Olorato Mathiba
- Pediatric DentistryThe University of the Western CapeCape TownSouth Africa
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Chen F, Cheng Y, Xie T. Oral Health Status of Young People Infected with HIV in High Epidemic Area of China. J Multidiscip Healthc 2021; 14:831-837. [PMID: 33907411 PMCID: PMC8068514 DOI: 10.2147/jmdh.s301236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to understand the oral hygiene habits and oral health status of young people infected with human immunodeficiency virus (HIV) in Henan province of China. Methods Randomized stratified cluster sampling strategy was used to select young people who were receiving highly active anti-retroviral therapy (HARRT) from 6 towns. A total of 104 participants were enrolled and divided into 2 groups, adolescence group and young adult group. By face-to-face oral interview and examination, well-trained dentists collected general information, oral hygiene habits and oral health status of the participants. Results Fifty-eight of them were adolescence group and 46 of them were young adult group. In two groups, most of them brushed their teeth once a day (55.20%, 67.40%), and half of them basically brushed their teeth for 2 minutes (51.7%, 50.0%). Majority of participants did not use dental floss (93.1%,91.3%) and also never visited a dentist (81%,78.3%). One-third of participants had spontaneous bleeding, and about half of them had gingival bleeding when brushed their teeth. The most frequent mucosal disease was oral ulcers. Moreover, the prevalence of caries remained very high in both groups, which was 82.76% and 84.8%, respectively. Most of the participants in both groups had low education level and received less than 9 years of education (65.5%, 63%). Conclusion The participants had poor oral hygiene habits. The economic and education level may associate with the awareness of oral health and care.
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Affiliation(s)
- Fei Chen
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, 310006, People's Republic of China
| | - Yuewu Cheng
- Shangcai Center for Disease Control and Prevention, Zhumadian, Henan, 463800, People's Republic of China
| | - Tiansheng Xie
- Zhejiang Sino-German Institute of Life Science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, Zhejiang, 310023, People's Republic of China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
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Kikuchi K, Yi S, Yasuoka J, Tuot S, Okawa S, Murayama M, Yem S, Chhoun P, Eng S, Huot C, Morokuma S. Oral health among HIV-positive and HIV-negative children in Phnom Penh, Cambodia: a cross-sectional study. BMJ Paediatr Open 2021; 5:e000992. [PMID: 33782657 PMCID: PMC7957132 DOI: 10.1136/bmjpo-2020-000992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND HIV-positive children are at high risk for oral mucosal disorders. Additionally, their low immune status is associated with dental caries. However, little is known about how their dental caries and related risk factors, such as salivary flow, salivary pH level and oral health-related quality of life, differ from those of HIV-negative children. The study aimed to assess (1) dental caries and related risk factors in HIV-positive compared with HIV-negative children and (2) the association between these factors and HIV seropositive status in Phnom Penh, Cambodia. METHODS This was a cross-sectional study conducted as a baseline survey of a randomised controlled trial. The study setting was the National Pediatric Hospital's catchment area. The study population comprised 328 HIV-positive and 154 HIV-negative children aged 3-15 years and their caregivers. We collected clinical oral health data, questionnaire data to assess oral health-related quality of life and growth data. RESULTS The mean number of decayed, missing or filled permanent teeth (DMFT) and deciduous teeth (dmft) among HIV-positive children was 4.0 (SD 3.6) and 7.0 (SD 4.9), respectively. Among HIV-negative children, the respective values were 3.3 (SD 3.7) and 7.1 (SD 4.6). Living with HIV was positively associated with DMFT (adjusted OR 1.85, 95% CI 1.14 to 3.01) and salivary flow (β=0.72, 95% CI 0.44 to 1.00) and negatively associated with salivary pH (β=-0.13, 95% CI -0.24 to -0.02). However, HIV-positive status was not significantly associated with dmft or oral health-related quality of life. CONCLUSIONS HIV-positive children had poorer oral health status regarding DMFT and salivary pH level. Specific strategies and further efforts are required to align their oral health status with that of HIV-negative children.
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Affiliation(s)
- Kimiyo Kikuchi
- Department of Health Sciences, Kyushu University, Fukuoka, Japan
| | - Siyan Yi
- KHANA Center for Population Health Research, KHANA Cambodia, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Junko Yasuoka
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Sovannary Tuot
- KHANA Center for Population Health Research, KHANA Cambodia, Phnom Penh, Cambodia.,Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Sokunthea Yem
- KHANA Center for Population Health Research, KHANA Cambodia, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, KHANA Cambodia, Phnom Penh, Cambodia
| | - Sothearith Eng
- KHANA Center for Population Health Research, KHANA Cambodia, Phnom Penh, Cambodia
| | | | - Seiichi Morokuma
- Department of Health Sciences, Kyushu University, Fukuoka, Japan
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Rafat Z, Sasani E, Salimi Y, Hajimohammadi S, Shenagari M, Roostaei D. The Prevalence, Etiological Agents, Clinical Features, Treatment, and Diagnosis of HIV-Associated Oral Candidiasis in Pediatrics Across the World: A Systematic Review and Meta-Analysis. Front Pediatr 2021; 9:805527. [PMID: 35004551 PMCID: PMC8740125 DOI: 10.3389/fped.2021.805527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022] Open
Abstract
In HIV-infected pediatrics, oral candidiasis (OC) is a global issue of concern due to its association with dysphagia, malnutrition, and mortality. The present systematic review and meta-analysis are the first to determine the prevalence of OC in HIV-infected pediatrics worldwide. We searched international (PubMed, Web of Science, Scopus, and Embase) databases for studies published between January 2000 to May 2020 reporting the epidemiologic features of OC in HIV-infected pediatrics. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA guidelines. The results of the meta-analysis were visualized as a forest plot. Heterogeneity was also analyzed using the I 2, and τ2 statistics. The publication bias was evaluated using Egger test. The literature search revealed 1926 studies, of which 34 studies met the eligibility criteria, consisting of 4,474 HIV-infected pediatrics from 12 different countries. The overall prevalence of OC among HIV-infected pediatrics was 23.9% (95% CI 17.3-32.0%), and Candida albicans was the most prevalent etiologic agent. Pseudomembranous candidiasis was the predominant clinical manifestation in HIV-infected pediatrics suffering from OC. Thirty articles involving 4,051 individuals provided data on HIV treatment status. Among the 4,051 individuals, 468 (11.53%) did not receive HIV treatment. The data from 11 articles demonstrated that HIV treatment was significantly associated with a reduction in oral Candida colonization or infection. In contrast, others showed the opposite relationship or did not report any statistical data. A high level of I 2 (I 2 = 96%, P < 0.01) and τ2 (τ2 = 1.36, P < 0.01) was obtained among studies, which provides evidence of notable heterogeneity between studies. OC is approximately frequent in HIV-positive children. Therefore, efforts should be made to teach dental and non-dental clinicians who care for HIV-infected pediatrics to diagnose and treat this infection.
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Affiliation(s)
- Zahra Rafat
- Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Sasani
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Yahya Salimi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samaneh Hajimohammadi
- Department of Toxicology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Shenagari
- Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Davoud Roostaei
- Department of Pharmacology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Shanmugavadivel G, Senthil Eagappan AR, Dinesh S, Balatandayoudham A, Sadish M, Kumar PP. Dental caries status of children receiving Highly active antiretroviral therapy (HAART) - A multicentric cross-sectional study in Tamil Nadu, India. J Family Med Prim Care 2020; 9:6147-6152. [PMID: 33681055 PMCID: PMC7928149 DOI: 10.4103/jfmpc.jfmpc_1032_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Highly active antiretroviral therapy (HAART) has progressively improved the life expectancies in HIV positive children. These antiretroviral drugs could possibly have an influence on the oral health status. Different age groups of children under HAART with caries had implications in approach to dental treatment, which were attempted to be identified in the study. Aims/Objectives: The aim of the study was to assess the caries status among HIV positive children receiving HAART. To characterize the age group with high caries indices and treatment needs. Methods: A cross-sectional study was conducted among 313 HIV infected children aged 3–14 years receiving HAART from various ART centers Tamil Nadu, India. Dental examinations were performed and caries status of primary and permanent dentition was assessed using Decayed, Missing, and Filled teeth (DMFT)/Decayed, Missing, and Filled surface (DMFS) indices. Statistical Analysis: The one way ANOVA with post-hoc Tukey HSD test. Results: The mean deft/DMFT scores were 3.15 ± 2.72/2.07 ± 1.31 and defs/DMFS scores were 7.42 ± 5.90/4.30 ± 2.58. The caries incidence was significantly different across the three age groups compared. DMFT scores of 13 − 14 years age group were significantly higher than in the 3−6 years (P < 0.0000) and 7−12 years (P < 0.0001). Conclusion: A higher caries experience was present among children on HAART as compared to the general population in Tamil Nadu. A significant association with increasing age and DMFT scores was noted. Age groups of 13−14 had high caries prevalence than age groups of 3−6 and 7−12 years in given study population. The individualized treatment approaches based on the age groups is suggested.
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Affiliation(s)
- G Shanmugavadivel
- Department of Pedodontics, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - A R Senthil Eagappan
- Department of Pedodontics and Preventive Dentistry, Chettinad Dental College and Research Institute, Kelambakkam, Tamil Nadu, India
| | - S Dinesh
- Department of Conservative Dentistry, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - A Balatandayoudham
- Department of Oral Surgery, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - M Sadish
- Department of Prosthodontics, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
| | - P Prasanna Kumar
- Department of Conservative Dentistry, Sri Venkateshwaraa Dental College, Ariyur, Pondicherry, India
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Birungi N, Fadnes LT, Engebretsen IMS, Lie SA, Tumwine JK, Åstrøm AN. Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children. BMC Public Health 2020; 20:423. [PMID: 32228542 PMCID: PMC7106612 DOI: 10.1186/s12889-020-08564-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Very few studies consider the oral health status and quality of life in HIV-1 exposed uninfected (HEU) children. The aim of this study was to estimate the prevalence of caries in primary teeth and its oral health related quality of life impacts in HEU children compared to HIV-unexposed-uninfected (HUU) children, whilst adjusting for confounding covariates. Methods This study uses data from the Ugandan site of the ANRS 121741 PROMISE- PEP trial (ClinicalTrials.gov, number NCT00640263) conducted in 2009–2013 that recruited mothers with HIV-1 and their uninfected children. Of 244 HEU-children-caretaker pairs available at the end of the one-year trial, 166 were re-enrolled in the ANRS 12341 PROMISE-PEP M&S study at 5–7 years and 164 were included in this study. These were age and sex-matched with 181 HUU children-caretaker comparators. Caries experience was recorded using World Health Organization’s Decayed, Missed and Filled teeth (dmft/DMFT) indices. The Early Childhood Oral health Impact Scale (ECOHIS) was used for assessment of oral health related quality of life. Mixed effects logistic regression was conducted with dmft and ECOHIS scores as outcomes and HIV-1 exposure status as the main exposure. Results Forty-eight percent of HEU children and 60% of HUU had dmft> 0. Corresponding figures for ECOHIS> 0 were 12% of HEU and 22% of HUU. The crude analysis showed differences related to HIV-1 exposure in caries experience and oral health related quality of life. Mixed effect logistic regression analyses were not significant when adjusted for use of dental care and toothache. If caregivers’ DMFT> 0, the adjusted odds ratio for caries experience (dmft> 0) was 1.6 (95% CI: 1.0–2.8) while if dmft> 0 the adjusted odds ratio for quality of life impacts (ECOHIS> 0) was 4.6 (95% CI: 2.0–10.6). Conclusion The prevalence of untreated caries in primary teeth and quality of life impacts was high in this study population. HIV-1 exposed uninfected children were not more likely than HUU children to experience dental caries or have impaired oral health related quality of life. Given the global expansion of the HEU child population, the present findings indicating no adverse effect of pre- and post-natal HIV-1 exposure on caries in deciduous teeth are reassuring.
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Affiliation(s)
- Nancy Birungi
- Department of Clinical Dentistry, University of Bergen, P. O Box 7800 5020, Bergen, Norway.
| | - Lars T Fadnes
- Department of Clinical Dentistry, University of Bergen, P. O Box 7800 5020, Bergen, Norway.,Bergen Addiction Research Group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ingunn M S Engebretsen
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, P. O Box 7800 5020, Bergen, Norway
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne Nordrehaug Åstrøm
- Department of Clinical Dentistry, University of Bergen, P. O Box 7800 5020, Bergen, Norway
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Mohamed N, Mathiba OP, Mulder R. Oral status of HIV-infected children aged 12 years or younger who attended a Paediatric Infectious Diseases Clinic in Cape Town. Clin Exp Dent Res 2020; 6:75-81. [PMID: 32067394 PMCID: PMC7025988 DOI: 10.1002/cre2.251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Children continue to suffer from the impact of the human immunodeficiency virus-acquired immunodeficiency syndrome (HIV/AIDS) pandemic. In Cape Town, these children receive medical care including antiretroviral therapy from facilities like Tygerberg Hospital's Paediatric Infectious Diseases Clinic. HIV-infected children may experience an increased caries experience when compared with their healthy peers. AIM The aim of this study was to determine the oral health status of HIV-infected children younger than 12 years receiving antiviral drugs at the Paediatric Infectious Diseases Clinic. DESIGN A cross-sectional survey was conducted among children aged between 2 and 12 years presenting at this clinic. Caregivers were interviewed to obtain information regarding health seeking behaviour, oral hygiene practices and dietary habits. A single clinician undertook a standardized clinical intraoral examination according to the World Health Organization guidelines, with modifications. RESULTS Sixty-six children were recruited. A high prevalence of dental caries (78.8%) and an unmet treatment need of 90.4% were recorded among the participants. Most children had never visited the dentist, and those who did had mainly received emergency dental care. CONCLUSION The high prevalence of severe dental caries in this population highlights the need for oral health awareness and the inclusion of oral health care in the comprehensive care of children with HIV. WHY THIS PAPER IS IMPORTANT TO PAEDIATRIC DENTISTS The study highlights the importance of collaborating with health professions outside of dentistry. Doctors and nurses are often the first health professionals to come into contact with children with special needs. They should therefore be made aware of the early signs of decay so that these patients can be referred for dental treatment timeously. Holistic management of children with special healthcare needs is essential to improve their overall well-being.
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Affiliation(s)
- Nadia Mohamed
- Department of Paediatric DentistryUniversity of the Western CapeCape TownSouth Africa
| | | | - Riaan Mulder
- Department of Paediatric DentistryUniversity of the Western CapeCape TownSouth Africa
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11
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Oral Manifestations in HIV-Positive Children: A Systematic Review. Pathogens 2020; 9:pathogens9020088. [PMID: 32023908 PMCID: PMC7168689 DOI: 10.3390/pathogens9020088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background: The number of pediatric patients affected by HIV still remains high, mainly in developing countries, where the main cause of infection is vertical transmission from the mother. Even today, a large number of these children do not have access to treatment, and, without proper care, they die in the first few years of life. Objective: The aim of our review was to assess the prevalence of oral hard and soft tissue lesions in HIV-positive pediatric patients by identifying the most common manifestations and the overall impact that they may have on the children’s quality of life. Study design: A systematic review of the articles in the English language in PubMed and Scopus was conducted in March 2019 in order to identify the main epidemiological and cross-sectional studies on the topic. Results: Oral diseases are still one of the most common manifestations in HIV-positive pediatric patients, and they often represent the first form in which immunosuppression shows itself. An analysis of the literature shows that candidiasis is the most common oral lesion found in HIV-positive children. A significant incidence of gingivitis and gingival disease is also evident, though not strictly correlated to HIV infection. However, thanks to the introduction of new antiretroviral therapies, the incidence of HIV-related oral lesions is decreasing. Conclusions: An HIV-positive children care program should also include dental protocols, as oral disease negatively influences the quality of life, affecting both functional and social aspects.
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Malele Kolisa Y, Yengopal V, Shumba K, Igumbor J. The burden of oral conditions among adolescents living with HIV at a clinic in Johannesburg, South Africa. PLoS One 2019; 14:e0222568. [PMID: 31618211 PMCID: PMC6795420 DOI: 10.1371/journal.pone.0222568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 09/03/2019] [Indexed: 01/13/2023] Open
Abstract
Background There are inconsistent reports on the prevalence of oral conditions and their associated factors among adolescents living with HIV (ALHIV). The current inconsistencies may hinder the development of clear guidelines on the prevention and treatment of oral conditions among ALHIV. This study provides an update on oral conditions and their associated factors in a cohort of South African ALHIV and receiving routine HIV treatment services at a Johannesburg HIV wellness clinic. Methods Decayed Teeth (DT), Decayed Missing and Filled Teeth (DMFT) and Oral HIV/AIDS Research Alliance case definitions were used for caries examination and reporting of the Oral Mucosal Lesions (OML) respectively. Data analyses were stratified by the study main outcomes; chi-squared tests were performed to determine the associations; and multiple logistic regressions were also used to identify associated factors after adjusting for other exposure variables. In addition to fitting logistic regressions, we explored the data for potential confounders and effect modifiers. Results A total of 407 ALHIV were assessed, of which 51.0% were females. The mean age of the ALHIV was 14.75 years (SD 2.43) while the median age of their parents was 43 years (IQR 37–48 years). Regardless of sex, age group and other socio-demographic characteristics, participants had high count of dental caries (DMFT>0). The overall prevalence of dental caries was 56.76% (n = 231) with mean DT score of 2.0 (SD 2.48) and mean DMFT score of 2.65 (SD 3.01). Dental caries prevalence (DT>0) was significantly associated with the HIV clinical markers. HIV RNA viral loads more than 1000 copies/ml and CD4 cell counts less than 200 count cells/mm3, increased the likelihood of having dental decay among ALHIV (p<0.05). ALHIV at WHO staging III, IV had higher caries prevalence ranging from 70% to 75% (p<0.05). The prevalence of dental caries was directly related to the presence of oral mucosal lesions (p<0.05). The prevalence of OML was 22%, with linear gingival erythema (13.8%) accounting for most of the OML. Multiple logistic regression modelling suggested that dental caries experience (DMFT>0), age category 13–15 years, WHO staging of IV and viral load of more than 1000 copies/ml significantly predicted the outcome of oral lesions as assessed using the OHARA case definitions (p<0.05). The odds of developing dental caries was also 1.5 times more among ALHIV who brush their teeth less frequently and those who reported more frequent eating of sugar sweetened diets (p<0.05). Conclusions There is high prevalence of dental caries and OML among ALHIV in Johannesburg. The reported prevalence was associated with high HIV RNA viral loads, shorter duration on antiretroviral treatment and high WHO staging of HIV disease on crude analysis. Additionally, caries experience contributed to the prevalence of OML. Our study acknowledges the protective effect of HIV treatment and positive oral health practices on the presence of oral conditions among ALHIV in Johannesburg.
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Affiliation(s)
- Yolanda Malele Kolisa
- School of Oral Health Sciences, Department of Community Dentistry, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Veerasamy Yengopal
- School of Oral Health Sciences, Department of Community Dentistry, University of the Witwatersrand, Johannesburg, South Africa
| | - Khumbo Shumba
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jude Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Sehgal HS, Kohli R, Pham E, Beck GE, Anderson JR. Tooth wear in patients treated with HIV anti-retroviral therapy. BMC Oral Health 2019; 19:129. [PMID: 31242887 PMCID: PMC6595590 DOI: 10.1186/s12903-019-0818-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study was to elucidate the relationship between HIV anti-retroviral therapy and tooth wear. Methods Assessment of tooth wear was conducted both with a survey questionnaire and clinical assessment at Russell Street Dental Clinic in Portland, Oregon. The survey questionnaire comprised of questions on study participant’s gender, age, HIV status, current medications, awareness of tooth grinding or clenching, jaw soreness, tooth or gum soreness, and frequency of headaches. For the clinical evaluation, a dental provider recorded the degree of wear on each tooth using a scale of 0–3. An individual tooth-wear index was used to rank patients with regard to incisal and occlusal wear. Data analysis included descriptive analysis, tests of association and regression analysis using SPSS V.24. Results The study sample involved 93 patients (HIV + ve = 60, HIV–ve = 33) with age range of 20-90 yrs. (mean = 49 yrs., s.d = 13.3). 92 and 67% participants of the HIV + ve and HIV-ve groups, respectively, presented with tooth wear. The mean tooth wear index was higher in HIV + ve patients than HIV–ve patients (8.2 vs. 7.8), however, this difference was not statistically significant (p > 0.05). A significant, positive correlation was found between HIV presence and tooth wear index, after accounting for age (B = 0.71, p < 0.05). The number of years on anti-retroviral therapy alone was positively correlated with tooth wear index (R2 = 0.116, p < 0.05). After controlling for age, years of anti-retroviral therapy use was positively correlated with tooth wear index (B = 0.047, p > 0.05). Conclusions The findings from this study suggest that HIV + ve patients, who are on anti-retroviral therapy have significant tooth wear, although more studies with larger sample size are needed to confirm this. There is a critical need to initiate a dialogue with medical providers about tooth wear as a possible side effect of antiretroviral therapy and to introduce appropriate preventive measures.
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Affiliation(s)
- Harjit Singh Sehgal
- Department of Periodontology, School of Dentistry, Oregon Health & Science University, 5N034 SDPERI, 2730 SW Moody Ave, Portland, Oregon, 97201-5042, USA.
| | - Richie Kohli
- Department of Community Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Edward Pham
- School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Grace E Beck
- Department of Endodontics, The University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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The association between oral disease and type of antiretroviral therapy among perinatally HIV-infected youth. AIDS 2018; 32:2497-2505. [PMID: 30096069 DOI: 10.1097/qad.0000000000001965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study explores the association between combination antiretroviral therapy (cART) and oral health outcomes (dental and periodontal) among perinatally HIV-infected (PHIV) youth. METHODS We conducted a cross-sectional study of oral health among PHIV youth participating in the Oral Health substudy of the Pediatric HIV/AIDS Cohort Study (PHACS). Dentists at research sites were trained/calibrated on how to perform a standardized oral mucosal, dental and periodontal examination. They assessed the decayed-missing-filled-surfaces and teeth index (DMFS/T). The number of decayed surfaces and teeth and the number of teeth with gingival bleeding on probing for each participant were derived from the examination. Data for analysis included lifetime measurements of CD4 cell count and viral load, sociodemographic information and current/past history of ART. RESULTS Among 209 PHIV youth, 95% were on ART at the time of enrolment. Among 143 PHIV youth on the same cART for at least 1 year, we found that the mean decayed teeth score of those receiving cART containing an integrase inhibitor was 86% higher than that of those on cART without an integrase inhibitor after adjusting for age, lifetime proportion of unsuppressed viral load and CD4 cell count nadir. Initiating protease inhibitors before age 6 years was associated with a significantly lower DMFT score than participants who initiated at age 6 years and older. CONCLUSION Our study revealed that PHIV youth who received cART containing an integrase inhibitor had a significantly higher number of untreated active caries than those on cART without an integrase inhibitor. This may warrant closer dental surveillance of those receiving an integrase inhibitor.
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Araújo JFD, Oliveira AEFD, Carvalho HLCCD, Roma FRVDO, Lopes FF. Most common oral manifestations in pediatric patients HIV positive and the effect of highly active antiretroviral therapy. CIENCIA & SAUDE COLETIVA 2018; 23:115-122. [PMID: 29267817 DOI: 10.1590/1413-81232018231.19072015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 12/18/2015] [Indexed: 11/21/2022] Open
Abstract
This integrative literature review aims to identify the main oral lesions affecting pediatric patients with HIV, and describe the effect of highly active antiretroviral therapy (HAART) on these injuries, comparing it to antiretroviral therapy (ART). A search was conducted in PubMed and Scielo databases, following predetermined inclusion and exclusion criteria. 19 papers were selected and the main information on the prevalence and frequency of oral manifestations in HIV-positive pediatric patients and effect of therapy applied were extracted. The most frequent injuries were oral candidiasis, gingivitis, parotid gland enlargement and linear gingival erythema. The use of HAART shown to reduce the prevalence of oral manifestations in pediatric patients with HIV and be more effective than ART. The findings of this study suggest that the most frequent oral manifestation in HIV-infected children is oral candidiasis, followed by changes such as gingivitis and enlargement parotid glands. The use of HAART appears to reduce the prevalence of these oral lesions, showing more effective results than ART.
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Affiliation(s)
- Joyce Figueira de Araújo
- Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil.
| | - Ana Emília Figueiredo de Oliveira
- Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil.
| | | | - Fábia Regina Vieira de Oliveira Roma
- Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil.
| | - Fernanda Ferreira Lopes
- Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil.
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Rajonson N, Meless D, Ba B, Faye M, Diby JS, N'zore S, Datté S, Diecket L, N'Diaye C, Aka EA, Kouakou K, Ba A, Ekouévi DK, Dabis F, Shiboski C, Arrivé E. High prevalence of dental caries among HIV-infected children in West Africa compared to uninfected siblings. J Public Health Dent 2017; 77:234-243. [PMID: 28233316 DOI: 10.1111/jphd.12203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/02/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The objectives of this study were to investigate the association between HIV infection and dental caries among children in West Africa, and to identify factors associated with dental caries among HIV-infected children. METHODS We conducted a multi-center cross-sectional study in Mali, Senegal and Côte d'Ivoire with a random sample of HIV-infected children aged 5-15 years on antiretroviral therapy and their uninfected siblings. A standardized examination was performed by calibrated dentists. The association between the number of decayed, missing or filled permanent and primary teeth surfaces (DMFdefS) and HIV status was investigated by fitting multivariable zero-inflated negative binomial models, for each age group (<12 and ≥12 years). Factors associated with dental caries could be investigated only for HIV-infected children <12 years old. RESULTS The sample included 420 HIV-infected children and 418 non-infected siblings. The median DMFdefS was 7 for the HIV-infected children and 2 for the uninfected siblings. The proportion of children with DMFdefS ≥1 was significantly higher among the HIV-infected children than uninfected children (86.0 percent versus 64.4 percent, P < 0.001). The HIV-infected children were less likely to be caries-free than the uninfected siblings in both age groups. We found a higher degree of caries experience among HIV-infected children < 12 years old, in whom it was associated with sweet drink consumption, history of night bottle use, immunosuppression, and younger age at study entry. CONCLUSIONS Although preventable, the burden of dental disease was high in children from families affected by HIV in West Africa and was associated with HIV infection and immunosuppression.
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Affiliation(s)
- Noëlla Rajonson
- Université de Bordeaux, UFR, d'Odontologie, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - David Meless
- Universite Felix Houphouet-Boigny, UFR d'Odontostomatologie, Abidjan, Côte d'Ivoire.,Programme PAC-CI/CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | - Malick Faye
- Hopital d'Enfants Albert Royer, Dakar, Senegal
| | | | - Serge N'zore
- Université de Cocody, CCTOS, Cocody, Abidjan, Côte d'Ivoire
| | | | | | | | | | | | - Abou Ba
- Hopital d'Enfants Albert Royer, Dakar, Senegal
| | | | - François Dabis
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France.,Université Bordeaux, ISPED, Centre INSERM U1219- Epidémiologie-Biostatistique, Bordeaux, France
| | - Caroline Shiboski
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Elise Arrivé
- Université de Bordeaux, UFR, d'Odontologie, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
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Moscicki AB, Yao TJ, Ryder MI, Russell JS, Dominy SS, Patel K, McKenna M, Van Dyke RB, Seage GR, Hazra R. The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth. PLoS One 2016; 11:e0156459. [PMID: 27299992 PMCID: PMC4907464 DOI: 10.1371/journal.pone.0156459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/13/2016] [Indexed: 01/27/2023] Open
Abstract
Objective To compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU). Methods In a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models. Results Eleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment. Conclusions Oral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions.
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Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mark I. Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
| | - Jonathan S. Russell
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Stephen S. Dominy
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kunjal Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Matt McKenna
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Russell B. Van Dyke
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - George R. Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California, United States of America
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Arrive E, Meless D, Anaya-Saavedra G, Gallottini M, Pinzon LM, Ramirez-Amador V. The global burden of oral diseases in pediatric HIV-infected populations: a workshop report. Oral Dis 2016; 22 Suppl 1:149-57. [PMID: 26882532 DOI: 10.1111/odi.12417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/22/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To achieve a comprehensive understanding about the global burden of oral diseases in HIV-infected children and to identify research needs. MATERIALS AND METHODS A literature search was conducted in PubMed (2009-2014) to address five questions: (i) prevalence of oral diseases in HIV-infected compared with uninfected children, (ii) impact of oral diseases on quality of life, (iii) effect of antiretroviral exposure in utero on craniofacial and dental development, (iv) important co-infections and antiretroviral complications, and (v) value of atraumatic restorative treatment. RESULTS Studies showed a high prevalence of dental caries in HIV-infected children but the relationship between HIV infection and dental caries remains unclear. Also quality of life needs further investigation supported by better study designs and improvement of the instruments used. Up-to-date evidence suggested long-term harms associated with in utero antiretroviral exposure were minor but would require long-term follow-up through National Registries. The reviews also revealed the wide spectrum of metabolic disease due to antiretroviral therapy and co-infections such as tuberculosis. Finally, atraumatic restorative technique appears to be a simple and safe technique to treat dental caries but outcomes need further evaluation. CONCLUSIONS The impact of antiretroviral therapy in HIV-infected children has raised novel challenging questions in the field of oral health warranting future research.
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Affiliation(s)
- E Arrive
- UFR d'Odontologie, University of Bordeaux, Bordeaux, France.,Equipe VIH et Santé Globale, INSERM U897, Bordeaux, France
| | - D Meless
- UFR d'Odontostomatologie, Félix Houphouët Boigny University of Abidjan, Abidjan, Côte d'Ivoire
| | - G Anaya-Saavedra
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
| | - M Gallottini
- Department of Stomatology, School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil
| | - L M Pinzon
- School of Dentistry, University of California, San Francisco, CA, USA.,School of Dentistry, University of Utah, Salt Lake City, UT, USA
| | - V Ramirez-Amador
- Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, México City, Mexico
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19
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Yengopal V, Kolisa Y, Thekiso MD, Molete MP. The child and adolescent with HIV in resource poor countries. Oral Dis 2016; 22 Suppl 1:25-34. [PMID: 26879655 DOI: 10.1111/odi.12411] [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] [Indexed: 11/28/2022]
Abstract
UNLABELLED Although sub-Saharan Africa caries the burden of paediatric and adult HIV/AIDS infections, the epidemic is spreading most rapidly in the Middle East and North Africa Region where between 2005 and 2013, AIDS-related deaths increased by 66% in comparison with a worldwide fall of 35%. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54%; yet only 28% of children have access to HIV treatment. This review sought to provide an update of paediatric and adolescent oral HIV/AIDS issues in resource poor countries. OBJECTIVES To review the literature on paediatric & adolescent HIV with a focus on oral lesions as predictors of HIV infection; as markers of the efficacy of HAART and quality of life; caries risk; management of oral lesions; and epidemiological tests for clinical significance of oral lesions. METHODS A search strategy was developed for PubMed to identify papers on paediatric oral HIV. Publications in English were selected on the basis that their titles and abstracts were relevant to the review objectives. The reference lists of included papers were screened for additional articles. The time-search for publications was limited from 2009 to 15 October 2014. RESULTS Papers on the prevalence of oral lesions lacked standardization in diagnostic criteria and the introduction of HAART had significantly reduced prevalence; oral lesions remain useful predictors for HIV infection and as markers for the efficacy of HAART. Evidence suggest that caries risk is increased with HIV infection; management of oral lesions is inconsistent with available resources and surprisingly little recent information has been published in the past 5 years. Revised case definitions are proposed for large-scale epidemiologic studies with the development of an oral lesion index showing promise. Oral health quality of life indicators for children and adolescents are becoming important as more of these indicators are being developed and their negative oral impacts in individuals with oral lesions are now well established. CONCLUSIONS Paediatric and adolescent oral HIV research needs to be prioritized as current studies are few and are characterized by poor quality study designs, small study samples and a lack of multicentre collaborations. There is a lack of high quality evidence for a number of interventions available for management of oral lesions.
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Affiliation(s)
- V Yengopal
- Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Y Kolisa
- Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M D Thekiso
- Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M P Molete
- Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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20
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Scully C, Samaranayake LP. Emerging and changing viral diseases in the new millennium. Oral Dis 2015; 22:171-9. [PMID: 26179810 PMCID: PMC7167660 DOI: 10.1111/odi.12356] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/14/2022]
Abstract
Most viral infections encountered in resource‐rich countries are relatively trivial and transient with perhaps fever, malaise, myalgia, rash (exanthema) and sometimes mucosal manifestations (enanthema), including oral in some. However, the apparent benignity may be illusory as some viral infections have unexpected consequences – such as the oncogenicity of some herpesviruses and human papillomaviruses. Infections are transmitted from various human or animal vectors, especially by close proximity, and the increasing movements of peoples across the globe, mean that infections hitherto confined largely to the tropics now appear worldwide. Global warming also increases the range of movement of vectors such as mosquitoes. Thus recent decades have seen a most dramatic change with the emergence globally also of new viral infections – notably human immunodeficiency viruses (HIV) – and the appearance of some other dangerous and sometimes lethal infections formerly seen mainly in, and reported from, resource‐poor areas especially in parts of Asia, Latin America and Africa. This study offers a brief update of the most salient new aspects of the important viral infections, especially those with known orofacial manifestations or other implications for oral health care.
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Affiliation(s)
- C Scully
- WHO Collaborating Centre for Oral Health-General Health, London.,UCL, London, UK
| | - L P Samaranayake
- Oral Microbiomics and Infection, School of Dentistry, University of Queensland, Brisbane, Qld, Australia
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21
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Gaitán-Cepeda LA, Sánchez-Vargas O, Castillo N. Prevalence of oral candidiasis in HIV/AIDS children in highly active antiretroviral therapy era. A literature analysis. Int J STD AIDS 2015; 26:625-32. [PMID: 25156369 DOI: 10.1177/0956462414548906] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/03/2014] [Indexed: 02/05/2023]
Abstract
SummaryHighly active antiretroviral therapy has decreased the morbidity and mortality related to HIV infection, including oral opportunistic infections. This paper offers an analysis of the scientific literature on the epidemiological aspects of oral candidiasis in HIV-positive children in the combination antiretroviral therapy era. An electronic databases search was made covering the highly active antiretroviral therapy era (1998 onwards). The terms used were oral lesions, oral candidiasis and their combination with highly active antiretroviral therapy and HIV/AIDS children. The following data were collected from each paper: year and country in which the investigation was conducted, antiretroviral treatment, oral candidiasis prevalence and diagnostic parameters (clinical or microbiological). Prevalence of oral candidiasis varied from 2.9% in American HIV-positive children undergoing highly active antiretroviral therapy to 88% in Chilean HIV-positive children without antiretroviral therapy. With respect to geographical location and antiretroviral treatment, higher oral candidiasis prevalence in HIV-positive children on combination antiretroviral therapy/antiretroviral therapy was reported in African children (79.1%) followed by 45.9% reported in Hindu children. In HIV-positive Chilean children on no antiretroviral therapy, high oral candidiasis prevalence was reported (88%) followed by Nigerian children (80%). Oral candidiasis is still frequent in HIV-positive children in the highly active antiretroviral therapy era irrespective of geographical location, race and use of antiretroviral therapy.
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Affiliation(s)
- Luis Alberto Gaitán-Cepeda
- Laboratory of Oral Pathology, Postgraduate and Research Division, Dental School, National Autonomous University of Mexico, Coyoacan, México
| | - Octavio Sánchez-Vargas
- Laboratory of Microbiology, Pathology and Biochemical, Faculty of Stomatology, Autonomous University of San Luis Potosi, San Luis Potosí, México
| | - Nydia Castillo
- Microbiology area, Health Sciences Center, Autonomous University of Baja California, Valle de las Palmas, Tijuana, Baja California, México
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22
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Rovaris NS, Galato D, Schuelter-Trevisol F, da Silva J, Linhar LDS, Nickel DA, Traebert J. Oral health status and its impact on the quality of life of children and adolescents living with HIV-1. BMC Res Notes 2014; 7:478. [PMID: 25069518 PMCID: PMC4118649 DOI: 10.1186/1756-0500-7-478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/21/2014] [Indexed: 11/12/2022] Open
Abstract
Background Oral health problems can generate considerable negative effects on the quality of life of individuals living with HIV. The aim of this study was investigate the oral health status and its impact on the quality of life of 1 to 18 years-old living with HIV-1 under follow-up at referral centers in Southern Brazil. Methods A cross-sectional study involving individuals under follow-up (n = 36) was carried out. The individuals living with HIV-1 and their guardians underwent individual interviews using validated questionnaires for assessing oral health-related quality of life according to age group. Clinical oral examinations were performed to establish oral health status, in terms of caries and treatment need, HIV-1-related gingival as well as stomatological changes. Medical records were reviewed searching for clinical history of the infection and the presence of HIV-1-related diseases. Association studies between frequent/very frequent oral health-related impact on quality of life and independent variables were performed using Fisher’s exact test. Results The prevalence of frequent/very frequent oral health-related impact on quality of life was 69.0%. The prevalence of caries was 75.9%. Gingival changes were present in 20.7% of the individuals. Dental treatment was needed in 72.4% of the patients. HIV-1-related disease was present in 55.2%. The variables significantly associated with the prevalence of frequent/very frequent impact on oral health-related quality of life were dental treatment need (p = 0.037) and being more than 12 years of age (p = 0.041). Conclusions Individuals living with HIV-1 with need for dental treatment and those over 12-years of age reported a statistically higher frequency of frequent/very frequent oral health-related impact on quality of life.
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Affiliation(s)
| | | | | | | | | | | | - Jefferson Traebert
- Graduate Program in Health Sciences, University of Southern Santa Catarina, 88704-900 Tubarão, SC, Brazil.
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