Prevalence of oral lesions and periodontal diseases in HIV-infected patients on antiretroviral therapy

Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Clinic Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.
European journal of medical research (Impact Factor: 1.5). 11/2005; 10(10):448-53.
Source: PubMed


A cross-sectional study examining oral manifestations was carried out in HIV-infected patients of a general HIV-specialized unit to provide prevalence data on oral lesions and periodontal diseases. The occurrence of oral lesions was correlated with demographic and clinical characteristics, immunologic and virologic parameters. Among 139 patients 86% presented any oral lesions with a prevalence of 76% of any periodontal diseases. Most periodontal lesions were classified as conventional gingivitis (28%) or periodontitis (30%). Dental plaque formation was associated with a higher prevalence of periodontal diseases (p = 0.01) and periodontal inflammation scores were higher in patients with more reduced CD4-counts (p = 0.03). Prevalence for HIV-specific oral lesions was 29% with a proportion of 9% of linear gingival erythema (LGE), 3.6% of necrotizing and ulcerative gingivitis (NUG) or periodontitis (NUP), 7% of oral candidiasis, 3.6% of oral hairy leucoplakia (OHL) and single other lesions. HIV-specific lesions (NUG/NUP, oral candidiasis and OHL) were found predominantly in patients with advanced immunosuppression and elevated viral load. Compared with data of oral diseases of the pre-HAART era prevalence of HIV-specific lesions was markedly reduced. Especially frequently known lesions such as oral candidiasis and OHL were less common seen. We noticed a shift of prevalence towards periodontal diseases. Lack of oral hygiene determined by plaque formation and reduced CD4-counts with pronounced periodontal inflammation can be seen as risk factors for periodontal disease. Overall high prevalence of manifestations underlines the importance of oral examination for the general practitioner and visits by oral specialists should become a routine procedure in HIV-patients care.

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Available from: Arne Kroidl, Mar 30, 2015
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    • "Low CD4+ lymphocyte counts are considered the main risk factor associated with the development of oral lesions in immunosuppressed individuals [34], and periodontal inflammation seems to be more severe in these individuals [35]. Published data suggest possible opportunistic behavior of E. gingivalis because the high parasite frequency and advanced periodontitis [18] have been correlated with low CD4+ lymphocyte counts [5] and with immunosuppression [16], [17]. "
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    ABSTRACT: Entamoeba gingivalis is considered an oral commensal but demonstrates a pathogenic potential associated with periodontal disease in immunocompromised individuals. Therefore, this study evaluated the occurrence, opportunistic conditions, and intraspecific genetic variability of E. gingivalis in HIV(+)/AIDS patients. Entamoeba gingivalis was studied using fresh examination (FE), culture, and PCR from bacterial plaque samples collected from 82 HIV(+)/AIDS patients. Genetic characterization of the lower ribosomal subunit of region 18S (18S-SSU rRNA) was conducted in 9 positive samples using low-stringency single specific primer PCR (LSSP-PCR) and sequencing analysis. Entamoeba gingivalis was detected in 63.4% (52/82) of the samples. No association was detected between the presence of E. gingivalis and the CD4(+) lymphocyte count (≤200 cells/mm(3) (p = 0.912) or viral load (p = 0.429). The LSSP-PCR results helped group E. gingivalis populations into 2 polymorphic groups (68.3% similarity): group I, associated with 63.6% (7/11) of the samples, and group II, associated with 36.4% (4/11) of the samples, which shared 74% and 83.7% similarity and association with C and E isolates from HIV(-) individuals, respectively. Sequencing of 4 samples demonstrated 99% identity with the reference strain ATCC 30927 and also showed 2 divergent clusters, similar to those detected by LSSP-PCR. Opportunistic behavior of E. gingivalis was not detected, which may be related to the use of highly active antiretroviral therapy by all HIV(+)/AIDS patients. The high occurrence of E. gingivalis in these patients can be influenced by multifactorial components not directly related to the CD4(+) lymphocyte counts, such as cholesterol and the oral microbiota host, which could mask the potential opportunistic ability of E. gingivalis. The identification of the 18S SSU-rRNA polymorphism by LSSP-PCR and sequencing analysis provides the first evidence of genetic variability in E. gingivalis isolated from HIV patients.
    Full-text · Article · Dec 2013 · PLoS ONE
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    • "However, these infections are still evidence of immunological damage in treated and untreated HIV-positive patients. Necrotizing periodontal diseases especially may indicate a CD4+ cell count below 200 cells/μL [3]. To reduce the risk of opportunistic infections, including oral manifestations, international medical associations developed guidelines for starting an antiretroviral treatment. "
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    ABSTRACT: Although severe oral opportunistic infections decreased with the implementation of highly active antiretroviral therapy, periodontitis is still a commonly described problem in patients infected with human immunodeficiency virus (HIV). The objective of the present investigation was to determine possible differences in periodontal parameters between antiretroviral treated and untreated patients. The study population comprised 80 patients infected with HIV divided into two groups. The first group was receiving antiretroviral therapy while the second group was therapy naive. The following parameters were examined: probing pocket depth, gingival recession, clinical attachment level, papilla bleeding score, periodontal screening index and the index for decayed, missed and filled teeth. A questionnaire concerning oral hygiene, dental care and smoking habits was filled out by the patients. There were no significant differences regarding the periodontal parameters between the groups except in the clinical marker for inflammation, the papilla bleeding score, which was twice as high (P < 0.0001) in the antiretroviral untreated group (0.58 ± 0.40 versus 1.02 ± 0.59). The participants of this investigation generally showed a prevalence of periodontitis comparable to that in healthy subjects. The results of the questionnaire were comparable between the two groups. There is no indication for advanced periodontal damage in HIV-infected versus non-infected patients in comparable age groups. Due to their immunodeficiency, HIV-infected patients should be monitored closely to prevent irreversible periodontal damage. Periodontal monitoring and early therapy is recommended independent of an indication for highly active antiretroviral therapy.
    Full-text · Article · Jan 2012
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    • "Conventional periodontitis progresses gradually, causing no or minimal pain or discomfort, being thus undiagnosed, until considerable tissue loss occurs (Alpagot et al, 2004). Generally , periodontal inflammation seems to be more severe in cases where CD4 + counts are low (Kroidl et al, 2005) and research nowadays is focused on the accelerated rate with which chronic adult periodontitis presents in seropositive patients (Lamster et al, 1997). Overall, findings from the above mentioned studies suggest the value of the identification of periodontal disease, even in patients on HAART therapy, in screening the immune suppression, both in diagnosed and undiagnosed HIV infection in adults. "
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    ABSTRACT: Oral Diseases (2010) 17, 13–25 HIV infection remains a global health problem of unprecedented dimensions, although the development of highly active antiretroviral therapy (HAART) has significantly modified the course of HIV disease into a manageable chronic disease with longer survival and improved quality of life in HIV-infected subjects. Among the HIV-associated infections, oral lesions have been recognized as prominent features since the beginning of the epidemic and continue to be important. Periodontal diseases strongly associated with HIV infection are classified as linear gingival erythema, necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis and are included among the cardinal oral lesions. Although oral candidiasis appears to be the infection more significantly decreased after the introduction of HAART, the current literature suggests that the prevalence and course of periodontal lesions have also been modified. Higher prevalence of opportunistic microorganisms has been frequently detected in the subgingival flora of HIV-infected individuals, probably due to the immune status of those patients, as colonization and overgrowth of atypical pathogenic species is facilitated by immunosuppression. Additional research is required regarding biological issues such as the role of oral immune factors and periodontal disease in the persistency of HIV infection, the possibility of oral transmission and the re-emerging of HIV infection.
    Full-text · Article · Oct 2010 · Oral Diseases
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