Oral manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome and their correlation to cluster of differentiation lymphocyte count in population of North-East India in highly active antiretroviral therapy era

Associated oral manifestations with HIV southeastern Brazilian patients on antiretroviral therapy

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").

Knowledge and attitude of dental students toward HIV infection in Umm Al-Qura University, Saudi Arabia

Context

Immunodeficiency virus infection is a major health crisis. It can spread to other people by transmission of the body fluid. The knowledge about this viral infection can aid in preventing its transmission and help in delivering successful dental care to these patients.

Aims

To evaluate the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-related knowledge and attitude of dental students and also to compare knowledge and attitude between a student's gender and different clinical levels (second, third vs. fourth to seventh years).

Settings and Design

A cross-sectional study was conducted among dental students at the college of dentistry in Umm Al-Qura University in Makkah, KSA.

Methods and Material

A validated survey was sent electronically to dental students from the second year to seventh year. The questionnaire contained 12 knowledge and 13 attitude questions about treating HIV/AIDS patients. Descriptive statistics were presented for the knowledge and attitude of the dental students about HIV/AIDS. Also, the knowledge and attitude were compared using t-test in relation to gender and clinical year.

Results

The response rate was 65%. The mean and standard deviation (SD) for the knowledge score was 8.32 ± 1.60 out of 12. There was no significant difference between gender and a student's clinical level. In the majority of the attitude questions, more than half of the students had favorable attitude toward HIV/AIDS subjects. Females had more favorable attitude as well as students with more clinical years of experience.

Conclusions

Dental students showed acceptable knowledge and positive attitude toward HIV/AIDS patients. Students who were females and with higher clinical years demonstrated better attitude but similar knowledge to males.

Total mouth photodynamic therapy mediated by red LED and porphyrin in individuals with AIDS

Due to the immune changes resulting from HIV/AIDS infection, systemic and local infections throughout the body are common. The use of high activity antiretroviral therapy has been widely used during treatment, which, added to the use of antibiotics, antifungals, and the patients' own immunocompromised state, cause important changes in the oral microbiota. The emergence of pathological microorganisms and with high resistance to drug therapies are frequent and cause serious damage to the oral health of these patients. In this sense, antimicrobial photodynamic therapy (aPDT) appears as a promising alternative in the control of these oral infections. The aim of the study was to test the effectiveness of a therapeutic protocol for total oral aPDT mediated by a 660-nm red LED (light-emitting diode) associated with porphyrin in individuals with AIDS. Patients were selected by exclusion criteria and randomly distributed into groups to test the effectiveness of antimicrobial aPDT with 50 µg/ml porphyrin associated with the red LED. Before and after the treatments, saliva samples were collected and processed in duplicate in selective culture media. Colonies were counted and the results obtained in Log10 CFU/ml and tested statistically. It was concluded that aPDT was effective in reducing oral enterobacteria, in addition to reducing Streptococcus spp. and general count of microorganisms, when considering the numbers of TCD4 and TCD8 lymphocytes.

Determinants of periodontitis according to the immunological and virological profiles of HIV-infected patients in Yaoundé, Cameroon

Background

HIV infection is associated to different oral manifestations (including periodontal diseases), which have decreased with the advent of antiretroviral therapy (ART). Yet, the occurrence of periodontitis is still consistent among patients with HIV living in sub Saharan-Africa, with limited evidence on the driven factors and mitigating measures in these settings. We aimed at evaluating the occurrence of periodontitis and its associated immunological and virological factors in patients with HIV living in Yaoundé, Cameroon.

Methods

We included 165 (44 ART-naïve and 121 ART-experienced) patients > 18 years old attending the Yaoundé Central Hospital and the Chantal BIYA International Reference Centre, from January-April 2018. The periodontal status was assessed by measuring the clinical attachment loss, periodontal pocket depth, plaques index and gingival bleeding index. CD4+/CD8+ cells and viremia were measured using the fluorescence-activated cell sorting method (FACS Calibur) and the Abbott m2000 RT HIV-1 RNA kit respectively. A standard-questionnaire concerning participants’ medical records and oral hygiene methods was filled. Data was analyzed and p < 0.05 considered statistically significant.

Results

There was a significantly high prevalence of periodontitis in the ART-naïve (53.2%) compared to the ART-experienced group (37.3%), with a twofold increased risk of the ART-naïve population presenting with periodontitis than the ART-experienced population (OR 2.06, p = 0.03). More importantly, ART-naïve, patients with CD4 < 200 cells presented with higher risk of having periodontitis compared to those with higher CD4-values, with a threefold difference (OR 3.21). Worth noting, males presented with a higher risk of having clinical attachment loss (OR 6.07). There was no significant association between the occurrence of periodontitis and the CD8 (p = 0.45) or viremia (p = 0.10).

Conclusion

In the Cameroonian context, a considerable number of adults infected with HIV suffer from periodontitis regardless of their treatment profile. Nonetheless, ART-naïve patients have a higher risk, indicating the protective role of ART. Interestingly, severely immune-compromised patients and men are vulnerable to periodontitis, thereby highlighting the need for clinicians to refer patients for regular periodontal screening especially male patients and those with low CD4. Such measures could greatly improve the quality of life of the population living with HIV in Cameroon.

CD4 cells count as a prognostic marker in HIV patients with comparative analysis of various studies in Asia Pacific region

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.

Assessing the levels of HIV-related knowledge and attitudes toward HIV-infected patients among undergraduate dental students: a cross-sectional study

Purpose

Worldwide, in the last decade, the numbers of new HIV infections and AIDS-related deaths have drastically decreased. Despite that, around 18 million infected individuals receive antiretroviral therapy and thus tend to live longer. This cross-sectional study was conducted to assess the level of HIV-related knowledge among undergraduate dental students at Ain Shams University (ASU) in Cairo, Egypt and to determine their attitudes toward treating HIV-positive patients.

Methods

The study sample included 247 undergraduate dental students of third, fourth, and fifth academic years at the Faculty of Dentistry, ASU who were randomly selected to participate in this survey. Data were collected using a self-administrated anonymous questionnaire. Chi square and ANOVA tests were used to measure differences in the level of knowledge and attitudes among students of the 3 years. Multiple linear regression analysis was performed with 95% confidence interval.

Results

Within the students’ population, around 94% incorrectly considered dentists to be at high risk of acquiring HIV infection and 47% believed that saliva is a vehicle for its transmission. Moreover, the majority of students were unaware of the association between HIV and common oral manifestations such as oral candida, Kaposi sarcoma, and leukoplakia. Although 69% of the students were willing to deliver oral care to people living with HIV (PLHIV), only 33% perceived themselves knowledgeable enough to do so.

Conclusion

Dental students were not adequately prepared to recognize and manage HIV-positive individuals. Thus, better education and training are required to raise their levels of HIV-related knowledge and enhance their capabilities to treat PLHIV.

Oral Localization of Kaposi Sarcoma: Clinical Presentation and Conservative Management

Kaposi sarcoma (KS) caused by human herpes virus type-8 is the most frequent immunosuppression-associated malignancy worldwide and its treatment is still controversial. We report on the clinical management of a patient who developed oral KS after liver transplantation. The disease appeared 1 month after the transplant and recurred after 4 months. The patient represents, to our knowledge, a rare case that was treated successfully only by shifting a conventional immunosuppressive therapy to everolimus alone.