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Novianti Y, Sufiawati I. Clinical Assessment and Management in Improving the Quality of Life of HIV/AIDS Patients with Oral Candidiasis: A Case Series. HIV AIDS (Auckl) 2023; 15:683-696. [PMID: 38028189 PMCID: PMC10656832 DOI: 10.2147/hiv.s434175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Oral candidiasis is the most prevalent opportunistic infection in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), impacting their quality of life. This report aims to emphasize the importance of clinical assessment and management of HIV/AIDS patients with oral candidiasis to improve their quality of life. Case Five male patients, aged between 32 and 71 years, came to the HIV clinic and complained of white plaques in their mouths and painful swallowing. The World Health Organization's (WHO) clinical staging of all patients was 4. Three patients had not yet received antiretroviral therapy (ART), and their total lymphocyte counts (TLC) of <1.170 cells/mm3. Two patients had dropped out of ART with CD4 counts were <40 cells/mm3. The body mass index of two patients was underweight, while the others were normal. The oral hygiene index simplified (OHI-S) of the patients was fair to poor. The quality of life assessment using the oral health impact profile 14 (OHIP-14) questionnaires before therapy showed values from 6-20. Clinical examination defined the diagnosis as oral candidiasis, exfoliative cheilitis, oral hairy leukoplakia, and a cytomegalovirus-related ulcer. Case Management The patients were treated with fluconazole, 0.2% chlorhexidine gluconate mouthwash, 2% miconazole cream, diphenhydramine, and multivitamins. The oral lesions were improved within 14 days to a month of treatment, and OHIP-14 scores were significantly reduced (0-3). Conclusion Clinical assessment is important in managing HIV/AIDS patients with oral candidiasis, which improves the patient's quality of life. Therefore, routine clinical assessment and management of HIV/AIDS patients are strongly recommended.
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Affiliation(s)
- Yessy Novianti
- Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Irna Sufiawati
- Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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Beall CJ, Lilly EA, Granada C, Treas K, Dubois KR, Hashmi SB, Vazquez JA, Hagensee ME, Griffen AL, Leys EJ, Fidel PL. Independent Effects of HIV and Antiretroviral Therapy on the Oral Microbiome Identified by Multivariate Analyses. mBio 2023; 14:e0040923. [PMID: 37071004 PMCID: PMC10294613 DOI: 10.1128/mbio.00409-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
The oral microbiome is an important predictor of health and disease. We recently reported significant yet modest effects of HIV under highly active antiretroviral therapy (ART) on the oral microbiome (bacterial and fungal) in a large cohort of HIV-positive (HIV+) and matched HIV-negative (HIV-) individuals. As it was unclear whether ART added to or masked further effects of HIV on the oral microbiome, the present study aimed to analyze the effects of HIV and ART independently, which also included HIV- subjects on preexposure prophylaxis (PrEP) therapy. Cross-sectional analyses of the effect of HIV devoid of ART (HIV+ ART- versus matched HIV- subjects) showed a significant effect on both the bacteriome and mycobiome (P < 0.024) after controlling for other clinical variables (permutational multivariate analysis of variance [PERMANOVA] of Bray-Curtis dissimilarity). Cross-sectional analyses evaluating the effects of ART (HIV+ ART+ versus HIV+ ART- subjects) revealed a significant effect on the mycobiome (P < 0.007) but not the bacteriome. In parallel longitudinal analyses, ART (before versus after the initiation of ART) had a significant effect on the bacteriome, but not the mycobiome, of HIV+ and HIV- PrEP subjects (P < 0.005 and P < 0.016, respectively). These analyses also revealed significant differences in the oral microbiome and several clinical variables between HIV- PrEP subjects (pre-PrEP) and the HIV-matched HIV- group (P < 0.001). At the species level, a small number of differences in both bacterial and fungal taxa were identified within the effects of HIV and/or ART. We conclude that the effects of HIV and ART on the oral microbiome are similar to those of the clinical variables but collectively are modest overall. IMPORTANCE The oral microbiome can be an important predictor of health and disease. For persons living with HIV (PLWH), HIV and highly active antiretroviral therapy (ART) may have a significant influence on their oral microbiome. We previously reported a significant effect of HIV with ART on both the bacteriome and mycobiome. It was unclear whether ART added to or masked further effects of HIV on the oral microbiome. Hence, it was important to evaluate the effects of HIV and ART independently. For this, multivariate cross-sectional and longitudinal oral microbiome analyses (bacteriome and mycobiome) were conducted within the cohort, including HIV+ ART+ subjects and HIV+ and HIV- (preexposure prophylaxis [PrEP]) subjects before and after the initiation of ART. While we report independent significant effects of HIV and ART on the oral microbiome, we conclude that their influence is similar to that of the clinical variables but collectively modest overall.
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Affiliation(s)
- Clifford J. Beall
- Division of Biosciences, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Elizabeth A. Lilly
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Center School of Dentistry, New Orleans, Louisiana, USA
| | - Carolina Granada
- Division of Infectious Diseases, Department of Medicine, Augusta University, Medical College of Georgia, Augusta, Georgia, USA
| | - Kelly Treas
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Center School of Dentistry, New Orleans, Louisiana, USA
| | - Kenneth R. Dubois
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Center School of Dentistry, New Orleans, Louisiana, USA
| | - Shahr B. Hashmi
- Division of Biosciences, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Jose A. Vazquez
- Division of Infectious Diseases, Department of Medicine, Augusta University, Medical College of Georgia, Augusta, Georgia, USA
| | - Michael E. Hagensee
- Section of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Ann L. Griffen
- Division of Biosciences, The Ohio State University College of Dentistry, Columbus, Ohio, USA
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Eugene J. Leys
- Division of Biosciences, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Paul L. Fidel
- Center of Excellence in Oral and Craniofacial Biology, Louisiana State University Health Center School of Dentistry, New Orleans, Louisiana, USA
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Lustosa de Souza BK, Faé DS, Lemos CAA, Verner FS, Machado RA, Ortega RM, de Aquino SN. Associated oral manifestations with HIV southeastern Brazilian patients on antiretroviral therapy. Braz J Otorhinolaryngol 2023; 89:425-431. [PMID: 36813599 PMCID: PMC10164786 DOI: 10.1016/j.bjorl.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/22/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. METHODS A cross-sectional study was conducted on a sample of 161 patients attending the… All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. RESULTS Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p=0.04), as well duration of treatment (p=1.53e-3) and age (p=0.02). Hyperpigmentation was related to race (p=0.01) and smoking (p=1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [-2.27 to -0.25]; p-value=0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR=8.47 [1.18-3.10], p= 1.31e-5), without race or type and duration of treatment. CONCLUSION Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. LEVEL OF EVIDENCE Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").
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Affiliation(s)
| | - Daniele Sorgatto Faé
- Universidade Federal de Juiz de Fora (UFJF-GV), Departamento de Odontologia, Governador Valadares, MG, Brazil
| | | | - Francielle Silvestre Verner
- Universidade Federal de Juiz de Fora (UFJF-GV), Departamento de Odontologia, Governador Valadares, MG, Brazil
| | - Renato Assis Machado
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Diagnóstico Bucal, Piracicaba, SP, Brazil
| | - Rose Mara Ortega
- Universidade Federal de Juiz de Fora (UFJF-GV), Departamento de Odontologia, Governador Valadares, MG, Brazil
| | - Sibele Nascimento de Aquino
- Universidade Federal de Juiz de Fora (UFJF-GV), Departamento de Odontologia, Governador Valadares, MG, Brazil.
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Jin Y, Yang T, Xia T, Shen Z, Ma T. Association between serum amylase levels and CD4 cell counts in newly diagnosed people living with HIV: A case-control study. Medicine (Baltimore) 2023; 102:e32638. [PMID: 36637942 PMCID: PMC9839261 DOI: 10.1097/md.0000000000032638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Serum amylase is a direct reflection of pancreatic injury. Several clinical studies have indicated that antiretroviral therapy may be the main cause of increased serum amylase in people living with human immunodeficiency virus (PLWH). However, other probable causes including direct human immunodeficiency virus infection, opportunistic infections and neoplasms, alcohol abuse, and use of illicit drugs, which can also affect pancreatic amylase levels were not considered in these studies. In our study, we collected clinical data from newly diagnosed PLWH who had not received antiretroviral therapy, and examined the association between serum amylase levels and CD4 cell counts. Between November 2018 and September 2021, a total of 344 newly diagnosed PLWH and 344 healthy controls were recruited at Ningbo Yinzhou No 2 Hospital. Serum amylase levels, CD4 cell counts and other clinical features were measured. Relationships between serum amylase levels and clinical parameters were evaluated using correlation analysis. Multiple linear regression analyses were performed to identify the independent risk factors. Newly diagnosed PLWH had lower CD4 cell counts and higher serum amylase levels than healthy controls (P < .05). Serum amylase levels were negatively correlated with CD4 cell counts (r = -0.506, P < .001). In multiple linear regression analyses, CD4 cell counts (β = -0.327, 95% confidence interval = -0.051--0.022, P < .001) were independently associated with serum amylase levels. CD4 cell counts were independently associated with serum amylase levels in newly diagnosed PLWH. Thus, close monitoring of serum amylase may be significant in preventing opportunistic infections of PLWH, since low CD4 cell counts are associated with an increased risk of opportunistic infections.
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Affiliation(s)
- Yong Jin
- Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Tianmeng Yang
- Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Ting Xia
- Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Zhihong Shen
- Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Tingting Ma
- Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
- * Correspondence: Tingting Ma, Department of Internal Medicine, Ningbo Yinzhou No.2 Hospital, Qianhe Rd No. 998, Ningbo, Zhejiang 315101, People’s Republic of China (e-mail: )
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Oral Manifestations Associated with HIV/AIDS Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091214. [PMID: 36143891 PMCID: PMC9504409 DOI: 10.3390/medicina58091214] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
Oral manifestations are early and important clinical indicators of Human Immunodeficiency Virus (HIV) infection since they can occur in up to 50% of HIV-infected patients and in up to 80% of patients at the AIDS stage (<200 CD4+ T lymphocytes). Oral health is related to physical and mental well-being because the presence of some lesions can compromise dental aesthetics, and alter speech, chewing, and swallowing, thus impacting the quality of life of patients. For this reason, it is necessary to integrate, as part of the medical treatment of HIV-positive patients, the prevention, diagnosis, and control of oral health. It is essential that health professionals have the power to identify, diagnose, and treat oral pathologies through clinical characteristics, etiological agents, and risk factors, both local and systemic. A diagnosis at an early stage of injury allows optimizing and prioritizing oral treatments, especially in acute pathologies, such as gingivitis and necrotizing periodontitis. In this group of patients, the development of strategies for the prevention, control, and reduction of these pathologies must be prioritized in order to reduce morbidity and mortality in this group of patients.
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Moosazadeh M, Shafaroudi AM, Gorji NE, Barzegari S, Nasiri P. Prevalence of oral lesions in patients with AIDS: a systematic review and meta-analysis. Evid Based Dent 2021:10.1038/s41432-021-0209-8. [PMID: 34795396 DOI: 10.1038/s41432-021-0209-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
Background Oral lesions are considered to be early clinical signs which may predict the progression of patients with acquired immune deficiency syndrome (AIDS). Due to the lack of a comprehensive study that includes oral lesions in people with AIDS, the global prevalence of oral lesions in people with AIDS was estimated by combining preliminary studies' results using meta-analysis.Material and methods Databases including PubMed, Science Direct and Scopus were searched using keywords as 'HIV', 'AIDS', 'oral candidiasis', 'Kaposi Sarcoma', 'LinearGingival Erythema' and OR operators, AND and NOT. After the elimination of duplicate documents, articles that met the inclusion criteria were selected. Quality assessment was performed based on the Newcastle-Ottawa Scale. After combining the results of preliminary studies, an overall estimate of each lesion was reported. Ninety-five studies met the criteria for inclusion in this meta-analysis.Results The global prevalence of 21 oral lesions in HIV-infected patients was estimated. The overall prevalence of oral candidiasis, pseudomembranous candidiasis, oral hairy leukoplakia, Kaposi sarcoma and erythematous candidiasis was as follows: 35% (95% CI: 28-42), 19% (95% CI: 15-22), 12% (95% CI: 11-14), 5% (95% CI: 4-6) and 18% (95% CI: 14-22).Conclusion The present meta-analysis showed that oral lesions have a high prevalence in patients with AIDS. Dentists should consider that the clinical appearance of the oral cavity reflects the overall systemic health of the patient. As such, oral lesions may be linked to underlying immunosuppression caused by AIDS.
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Affiliation(s)
- Mahmood Moosazadeh
- PhD in Epidemiology, Associate Professor, Gastrointestinal Cancer Research Centre, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Malekzadeh Shafaroudi
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nadia Elyassi Gorji
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Barzegari
- PhD in Health Information Management, Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Pegah Nasiri
- Dentistry Student, Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
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Abe EO, Adisa AO, Adeyemi BF, Awolude OA, Owotade FJ. Relationship between CD4 + count, serum inflammatory cytokines, and oral melanotic hyperpigmentation in newly diagnosed HIV-seropositive patients: a nested case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:182-188. [PMID: 34857496 DOI: 10.1016/j.oooo.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Oral melanotic hyperpigmentation (OMH) in patients with human immunodeficiency virus (HIV) infection has been attributed to the use of antifungal or antiretroviral drugs, as well as HIV-induced cytokine dysregulation. This research aimed to determine the relationship between immunosuppression and cytokine dysregulation in newly diagnosed HIV-seropositive subjects with OMH. STUDY DESIGN The study was conducted among newly diagnosed HIV-seropositive patients at the Infectious Disease Clinic, Ibadan, Nigeria. The cases were patients with OMH matched for age and sex with control subjects without OMH. CD4+ count and cytokine levels (interleukin-6 and tumor necrosis factor-α) were compared between the cases and control subjects. SPSS version 21 software was used for data analysis. RESULTS Seventy newly diagnosed HIV-seropositive patients were studied, which comprised of 35 cases and 35 control subjects. The median CD4+ counts for cases and control subjects were 174 cells/mm3 (interquartile range [IQR], 57-250) and 324 cells/mm3 (IQR, 107-424), respectively. Severe immunosuppression (CD4+ count, ≤200 cells/mm3) was found in over half of the study participants, being more prevalent among the cases than among the control group (P = .019). Serum cytokine levels did not significantly vary between the cases and control subjects. CONCLUSIONS There was a significant association between HIV-OMH and severe immunosuppression in the newly diagnosed HIV-seropositive patients.
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Affiliation(s)
| | | | | | | | - Foluso John Owotade
- Department of Oral Pathology/Oral Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
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Li S, Su B, He QS, Wu H, Zhang T. Alterations in the oral microbiome in HIV infection: causes, effects and potential interventions. Chin Med J (Engl) 2021; 134:2788-2798. [PMID: 34670249 PMCID: PMC8667981 DOI: 10.1097/cm9.0000000000001825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
ABSTRACT A massive depletion of CD4+ T lymphocytes has been described in early and acute human immunodeficiency virus (HIV) infection, leading to an imbalance between the human microbiome and immune responses. In recent years, a growing interest in the alterations in gut microbiota in HIV infection has led to many studies; however, only few studies have been conducted to explore the importance of oral microbiome in HIV-infected individuals. Evidence has indicated the dysbiosis of oral microbiota in people living with HIV (PLWH). Potential mechanisms might be related to the immunodeficiency in the oral cavity of HIV-infected individuals, including changes in secretory components such as reduced levels of enzymes and proteins in saliva and altered cellular components involved in the reduction and dysfunction of innate and adaptive immune cells. As a result, disrupted oral immunity in HIV-infected individuals leads to an imbalance between the oral microbiome and local immune responses, which may contribute to the development of HIV-related diseases and HIV-associated non-acquired immunodeficiency syndrome comorbidities. Although the introduction of antiretroviral therapy (ART) has led to a significant decrease in occurrence of the opportunistic oral infections in HIV-infected individuals, the dysbiosis in oral microbiome persists. Furthermore, several studies with the aim to investigate the ability of probiotics to regulate the dysbiosis of oral microbiota in HIV-infected individuals are ongoing. However, the effects of ART and probiotics on oral microbiome in HIV-infected individuals remain unclear. In this article, we review the composition of the oral microbiome in healthy and HIV-infected individuals and the possible effect of oral microbiome on HIV-associated oral diseases. We also discuss how ART and probiotics influence the oral microbiome in HIV infection. We believe that a deeper understanding of composition and function of the oral microbiome is critical for the development of effective preventive and therapeutic strategies for HIV infection.
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Affiliation(s)
- Shuang Li
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Qiu-Shui He
- Institute of Biomedicine, Research Center for Infections and Immunity, University of Turku, Turku 20520, Finland
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
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Abstract
The oral microbiome is likely a key element of homeostasis in the oral cavity. With >600 bacterial species and >160 fungal species comprising the oral microbiome, influences on its composition can have an impact on both local and systemic health. The oral microbiome is considered an important factor in health and disease. We recently reported significant effects of HIV and several other clinical variables on the oral bacterial communities in a large cohort of HIV-positive and -negative individuals. The purpose of the present study was to similarly analyze the oral mycobiome in the same cohort. To identify fungi, the internal transcribed spacer 2 (ITS2) of the fungal rRNA genes was sequenced using oral rinse samples from 149 HIV-positive and 88 HIV-negative subjects that had previously undergone bacterial amplicon sequencing. Quantitative PCR was performed for total fungal content and total bacterial content. Interestingly, samples often showed predominance of a single fungal species with four major clusters predominated by Candida albicans, Candida dubliniensis, Malassezia restricta, or Saccharomyces cerevisiae. Quantitative PCR analysis showed the Candida-dominated sample clusters had significantly higher total fungal abundance than the Malassezia or Saccharomyces species. Of the 25 clinical variables evaluated for potential influences on the oral mycobiome, significant effects were associated with caries status, geographical site of sampling, sex, HIV under highly active antiretroviral therapy (HAART), and missing teeth, in rank order of statistical significance. Investigating specific interactions between fungi and bacteria in the samples often showed Candida species positively correlated with Firmicutes or Actinobacteria and negatively correlated with Fusobacteria, Proteobacteria, and Bacteroidetes. Our data suggest that the oral mycobiome, while diverse, is often dominated by a limited number of species per individual; is affected by several clinical variables, including HIV positivity and HAART; and shows genera-specific associations with bacterial groups.
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Obradović R, Kesić L, Pejčić A, Bojović M, Petrović M, Stanković I, Jovanović M, Popović Ž. Management of recurrent aphthous stomatitis in HIV. ACTA STOMATOLOGICA NAISSI 2021. [DOI: 10.5937/asn2183203o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Today, human immunodeficiency virus (HIV) infection is often health problem. People with HIV are living longer and more of them are seeking care for the oral complications of this disease. This is the reason why the management of HIV infection is regular in the dental and medical everyday practice. Although HIV-related recurrent aphthous stomatitis (RAS) constitute a small percentage of oral lesions they are one of the most painful conditions of the oral cavity. The aim: is to point out the therapeutic possibilities and health improvement in people with HIV. Conclusion: Once a diagnosis of RAS is reached, the choice of a specific treatment modality is individual and the potential side effects of drugs should always be taken into account. It is important to reduce pain and achieve a prolonged remission.
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Vohra P, Nimonkar S, Belkhode V, Potdar S, Bhanot R, Izna, Tiwari RVC. CD4 cells count as a prognostic marker in HIV patients with comparative analysis of various studies in Asia Pacific region. J Family Med Prim Care 2020; 9:2431-2436. [PMID: 32754515 PMCID: PMC7380754 DOI: 10.4103/jfmpc.jfmpc_137_20] [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: 01/21/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: To evaluate the correlation between CD4+ cells count with orofacial and systemic manifestations in newly diagnosed HIV seropositive patients and comparison of results with the previous studies. Materials and Methods: Hundred (100; 57 males and 43 females) newly diagnosed HIV seropositive patients, before starting antiretroviral therapy (ART) were included in the study. These patients were clustered according to CD4+ cells count into three groups: 0–200 cells/mm3, 201–499 cells/mm3, and more than 500 cells/mm3. Orofacial and systemic manifestations of these patients were recorded and correlated with CD4 cells count values. Results: There was no significant correlation found between CD4+ cells count values of males and females using independent t-test. Chi-square test showed significant correlation between the systemic manifestations and CD4+ cells count categories. Tuberculosis was found to be the most common systemic manifestation in both the genders. In addition, a significant correlation was between the CD4+ cells count and orofacial manifestations, where oral candidiasis was found to be the most common manifestation in both the genders. Conclusion: The prevalence of systemic and orofacial manifestations increases with decrease in the CD4+ cells count of HIV seropositive patients. Hence, it can be used as diagnostic and prognostic marker for immune suppression in HIV positive patients.
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Affiliation(s)
- Puneeta Vohra
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, S.G.T. University, Gurugram, Haryana, India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra, India
| | - Vikram Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra, India
| | - Suraj Potdar
- Department of Orthodontics and Dentofacial Orthopedics, Vasantdada Patil Dental College and Hospital, Kavalapur, Maharashtra, India
| | - Rishabh Bhanot
- Consultant Oral and Maxillofacial Surgeon, Jyoti Kendra General Hospital, Ludhiana, Punjab, India
| | - Izna
- Department of microbiology, Government Medical College and associated Hospital Rajouri, Jammu and Kashmir, India
| | - Rahul V C Tiwari
- Consultant Oral and Maxillofacial Surgeon, Clove Dental and OMNI Hospitals, Visakhapatnam, Andhra Pradesh, India
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Schander A, Glickman AA, Weber N, Rodgers B, Carney MB. A 45-year-old Female with an Atypical Presentation of Pharyngitis. Clin Pract Cases Emerg Med 2020; 4:234-240. [PMID: 32426682 PMCID: PMC7219994 DOI: 10.5811/cpcem.2020.2.46974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 02/22/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses. Case Presentation The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative. Discussion After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.
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Affiliation(s)
- Artur Schander
- Sacred Heart Hospital, Department of Emergency Medicine, Pensacola, Florida
| | - Andrew A Glickman
- HCA/USF Morsani College of Medicine GME Consortium: Brandon Regional Hospital, Department of Emergency Medicine, Brandon, Florida
| | - Nancy Weber
- Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas.,Paul L. Foster School of Medicine, Department of Emergency Medicine, El Paso, Texas
| | | | - Michael B Carney
- Reynold's Memorial Hospital, Department of Emergency Medicine, Glen Dale, West Virginia
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Immunohistochemical Expression Patterns of Inflammatory Cells Involved in Chronic Hyperplastic Candidosis. Pathogens 2019; 8:pathogens8040232. [PMID: 31718115 PMCID: PMC6963680 DOI: 10.3390/pathogens8040232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 11/17/2022] Open
Abstract
The profile of the inflammatory cell infiltrate in chronic hyperplastic candidosis (CHC) was determined in oral mucosal biopsies by immunohistochemistry. One tonsillar tissue section was included as an immunohistochemistry control, whilst squamous papilloma (n = 4) with secondary Candida infection was used as Candida controls. Oral lichen planus tissues (n = 10) provided negative controls for Candida presence, as well as positive controls for inflammation. Immunohistochemistry employed antibodies specific for CD3+ (T lymphocytes), CD4+ (T helper cells), CD8+ (cytotoxic T cells), and CD20+ (B lymphocytes). Manual counting of stained cells from digitised images determined the proportion of each cell type relative to the total number of cells, and these were assessed in the mucosa, the epithelium, and the lamina propria. The mean proportion of CD3+ cells was significantly higher than CD20+ cells in all tissue types. For CHC, the mean proportion of CD3+ cells in entire tissues was 15.6%, with the highest proportion in the lamina propria (32.6%) compared with the epithelium (3.9%). CD20+ cells were in much lower proportions (1.8%) in CHC, with the highest proportion (3.6%) in the lamina propria. T lymphocytes were predominately CD4+ cells (9.0%) compared with CD8+ cells (4.4%). CD4+ cells were most prevalent in the lamina propria (23.1%) compared with the epithelium (mean = 3.2%). From these results, it was concluded that the immune response invoked by Candida in CHC is primarily driven by the T helper cells.
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14
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Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MSN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care 2019; 8:3247-3252. [PMID: 31742150 PMCID: PMC6857402 DOI: 10.4103/jfmpc.jfmpc_767_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/16/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022] Open
Abstract
AIM Aim of the study was to correlate CD4 counts with oral and systemic manifestations in HIV patients. MATERIALS AND METHODS Study population comprised of newly diagnosed 100 confirmed seropositive patients, before starting any antiretroviral therapy, were included. The oral lesions were diagnosed based on clinical manifestation using international criteria and CD4 count was determined within maximum 1 week of oral examination. Oral and systemic manifestations of HIV-positive patients were recorded and correlated with CD4 counts. RESULTS It was found that decrease in CD4 count is associated with a wide range of oral and systemic manifestations which can be used as prognostic marker for immune suppression in AIDS patient. CONCLUSION Correlation of CD4 count with oral and systemic manifestation in HIV patient demonstrate the role of oral physician in identification, diagnosis, and treatment of HIV-associated lesions, providing proper guidance to the patient and allowing for an early diagnosis and treatment of the disease, which is fundamental for a successful management of the life conditions of HIV infected patients.
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Affiliation(s)
- Puneeta Vohra
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
| | - Kahamnuk Jamatia
- Department of Dentistry, AGMC and GBP Hospital, Agartala, Tripura, India
| | - B Subhada
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Rahul Vinay Chandra Tiwari
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - MS Nabeel Althaf
- Department of Periodontology, Kavil's Smiley Multi Specialty Dental Clinic, Uppala, Kasaragod, Kerala, India
| | - Chayan Jain
- Department of Pedodontics and Preventive Dentistry, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India
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15
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Kim SM, Lee JH. Importance of various oral manifestations regardless of CD4 cell count in HIV/AIDS patients. J Korean Assoc Oral Maxillofac Surg 2019; 44:298-301. [PMID: 30637245 PMCID: PMC6327012 DOI: 10.5125/jkaoms.2018.44.6.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Soung Min Kim
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, Sunyani, Ghana.,Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - Jong Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
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16
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Liu Z, Yong X, Jiang L, Zhang L, Lin X, Liu W, Peng Y, Tao R. Salivary human beta-defensins affected by oral Candida status in Chinese HIV/AIDS patients undergoing ART. Oral Dis 2018; 24:964-971. [PMID: 29498794 DOI: 10.1111/odi.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/08/2018] [Accepted: 02/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To observe relationships between oral Candida status and salivary human beta-defensin 2 and 3 (hBD-2 and hBD-3) levels in HIV/AIDS patients of Guangxi, China during the first year of antiretroviral therapy (ART) dynamically, and to understand the influence of ART on oral Candida status and salivary hBDs expressions. METHODS A prospective self-controlled study was carried to observe the dynamic changes of CD4+ T cell counts, oral Candida carriages and salivary hBD-2,3 expressions in HIV/AIDS patients during the first year of ART. A total of 90 HIV/AIDS patients were enrolled and were examined at the baseline, 3rd, 6th, 12th month of ART. Thirty healthy individuals were enrolled as control. Peripheral blood, oral rinse sample, and unstimulated whole saliva were collected to test CD4+ T cell counts, oral Candida carriages, and hBD-2,3 expressions. RESULTS In the first year of ART, CD4+ T cell counts increased significantly. However, oral Candida carriages and oral candidiasis decreased significantly, and salivary hBD-2 expressions in HIV/AIDS patients decreased gradually, salivary hBD-3 levels were highly variable. Salivary hBD-2 concentrations were positively related to oral Candida carriages. CONCLUSIONS The incidence of oral candidiasis among HIV/AIDS patients gradually decreased due to the immune reconstruction of ART. Salivary defensins might play an important role in Candida-host interaction in HIV/AIDS patients.
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Affiliation(s)
- Z Liu
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Guangxi, China
| | - X Yong
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - L Jiang
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - L Zhang
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - X Lin
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - W Liu
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention (CDC), Guangxi, China
| | - Y Peng
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - R Tao
- Department of Periodontics and Oral Medicine, College of Stomatology, Guangxi Medical University, Nanning, Guangxi, China.,Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Guangxi, China
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Berberi A, Aoun G. Oral lesions associated with human immunodeficiency virus in 75 adult patients: a clinical study. J Korean Assoc Oral Maxillofac Surg 2017; 43:388-394. [PMID: 29333368 PMCID: PMC5756795 DOI: 10.5125/jkaoms.2017.43.6.388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Objectives The objective of this study was to investigate the presence of oral lesions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in a descriptive cross-sectional study, and to establish their presence according to levels of CD4+ cells (including the CD4+/CD8+ cell ratio). Materials and Methods A total of 75 patients infected with HIV were included. Oral lesions were observed and classified using World Health Organization classification guidelines. Potential correlations between the presence and severity of oral lesions and CD4+ cells, including the CD4+/CD8+ cell ratio, were studied. Results The most frequent oral lesion detected was oral pseudomembranous candidiasis (80.0%), followed by periodontal disease (40.0%), herpetic lesions (16.0%), hairy leukoplakia (16.0%), gingivitis (20.0%), oral ulceration (12.0%), Kaposi's sarcoma (8.0%), and non-Hodgkin's lymphoma (4.0%). The CD4+ count was <200 cells/mm3 in 45 cases (60.0%), between 200–500 cells/mm3 in 18 cases (24.0%), and >500 cells/mm3 in 12 cases (16.0%). The mean CD4+ count was 182.18 cells/mm3. The mean ratio of CD4+/CD8+ cells was 0.26. All patients showed at least one oral manifestation. Conclusion There was no correlation between the CD4+/CD8+ cell ratio and the presence of oral lesions. The severity of the lesions was more pronounced when the CD4+ cell count was less than 200 cells/mm3.
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Affiliation(s)
- Antoine Berberi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - Georges Aoun
- Department of Oral Medicine and Diagnosis, School of Dentistry, Lebanese University, Beirut, Lebanon
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