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

Abstract

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.

Relationship between CD4+ T‐cell counts at baseline and initial periodontal treatment efficacy in patients undergoing treatment for HIV infection: A retrospective observational study

“…In the present study, no difference in the PISA was found between the groups with CD4+ cell counts of ≥500/mm 3 and <500/mm 3 or between the HIV detection and HIV non-detection groups. The lack of any difference in the PISA is consistent with previous reports that periodontal disease indicators such as PPD (≥4 mm) and BOP are not associated with CD4+ T-cell counts (Fokam et al, 2020;Gonçalves et al, 2005;John et al, 2013;Ravi & Rao, 2015). examination were significantly lower after the initial periodontal treatment than those at baseline.…”

“…Some studies have reported that patients with HIV infection and high CD4+ T-cell counts have more advanced periodontal diseases than those with low CD4+ T-cell counts (McKaig et al, 2000;Valentine et al, 2016). Other studies have found no difference in the pathogenesis of periodontitis according to the CD4+ T-cell counts (Fokam et al, 2020;John et al, 2013). Thus, the effect of CD4+ T-cell counts on the pathogenesis of periodontitis remains controversial.…”

Men with HIV Have Increased Alveolar Bone Loss

“…Interestingly, men in the aforementioned study had signi cantly higher risk of clinical attachment loss than women [4].…”

“…With the use of effective antiretroviral therapy (ART), people living with HIV (PLWH) experience life expectancies similar to people without HIV and encounter many more aging-related comorbidities [3] than opportunistic infections. A recent study con rmed the protective role of ART as the prevalence of periodontitis in PLWH not receiving ART was two times greater than those PLWH receiving ART [4].…”

Characterization of oral candidiasis according to antiretroviral treatment status, immunological and virological profiles among HIV infected patients in two health facilities in Yaounde Cameroon: a cross-sectional and analytical study

“…A study done in France in 2014, reported that pseudomembranous (25%) and erythematous (13.9%) candidiasis were the most encountered forms of oral candidiasis [ 11 ]. Meanwhile, in Cameroon, a study demonstrated the presence of periodontitis in HIV-infected people in Yaoundé, with a significantly high morbidity in those with a deleterious immune status (53.2%) but without exploration of the typology [ 12 ]. In order to limit HIV related oral disease and to optimize oral healthcare among PLHIV, we evaluated the type and distribution of oral candidiasis with respect to ART-profile including both immunological and virological profiles of PLHIV in two health facilities (Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) and the Jamot Hospital of Yaoundé); which are respectively among the leading HIV/AIDS monitoring (viral load and CD4 count) and treatment sites in Yaoundé.…”