Our results suggest that epithelial cells can be productively infected by HIV. Epithelial cells in buccal mucosa may acquire HIV in the basal layers through contact with submucosal HIV-positive lymphocytes and/or Langerhans' cells. HIV infection may also spread by inter-epithelial cell contact. As HIV infected cells mature they travel to more superficial layers and are shed into the oral cavity.

OBJECTIVE: To determine whether a significant association occurs between the presence of various periodontal diseases and recoverable infectious HIV‐1 in the saliva of injecting drug users. DESIGN: Five hundred and fifty‐one injecting drug users were recruited from various programs associated with the Beth Israel Medical Center. Examiners were ‘blinded’ to the subject's HIV‐1 serostatus. A socio‐economic and risk factors’ survey was conducted and a complete oral examination, including periodontal disease indices was performed. Whole saliva and blood were collected for virus culture. MAIN OUTCOME MEASURES: Recovery of infectious HIV‐1 in saliva related to presence of periodontal diseases. RESULTS: Those HIV‐1 seropositive subjects with periodontal diseases did not differ from those HIV‐1 seropositive subjects without periodontal disease in mean age and immune status. Less than 1% of the HIV‐1 seropositive subjects had cultivable HIV‐1 in their saliva while it was present in 78% of PBMCs and 35% of the sera. There was no significant association between infectious HIV‐1 in saliva, serum, or PBMCs and any of the various periodontal diseases. CONCLUSIONS: The presence of periodontal disease in HIV‐1 seropositive injecting drug users does not appear to be a potential risk factor for infectious HIV‐1 in saliva, probably due to the various anti‐viral components of saliva.

OBJECTIVE: This study evaluates the real world persistency of therapy for overactive bladder (OAB), comparing tolterodine, oxybutynin and flavoxate head‐to‐head in a large sample extracted from a US drug claim database. Clinical trials have shown tolterodine has equal efficacy to oxybutynin in reduction of OAB symptoms and a significantly better side‐effect profile. METHOD: A longitudinal study was conducted using drug claims from PCS Health Systems. The study cohort consists of 4602 “naïve tolterodine users”, 7291 “naïve oxybutynin users” and 2127 “naive flavoxate users.” Survival analysis was used to estimate the “persistence rate”—defined as the proportion of patients who are still on a drug treatment during or after a defined period of continuous treatment for the drug. A Cox‐regression model was used to assess the net effect of using tolterodine or oxybutynin on the persistence of drug therapy controlling for differences in the patients' demographics, comorbid conditions, and other factors. RESULTS: The persistence on tolterodine was 30% higher than that on oxybutynin on continuous treatment periods of 31–60 days, and 90% higher for 301–360 days of therapy. The persistence on tolterodine was 430% higher than that on flavoxate for treatment periods of 30–60 days and 340% higher for 301–360 days of therapy. The average length of continuous treatment for naive tolterodine users was the longest of the three drugs: 143(3.9) days compared to 91(2.6) days for oxybutynin and 41(4.6) days for flavoxate. The adjusted odds‐ratio of terminating drug treatment for tolterodine vs. oxybutynin users was 0.66 (p> 0.001). CONCLUSIONS: Patients using tolterodine were significantly more likely to continue their treatment than those choosing other OAB drugs. The better persistence for tolterodine users should result in longer symptom relief for patients, particularly for those who are in need of long‐term treatment but are distressed by side effects.

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