Gingival tissue as a reservoir for human immunodeficiency virus type 1: Preliminary results of a cross‐sectional observational study

Abstract

Background Despite combined antiretroviral therapy (cART), total cure of immunodeficiency virus type 1 (HIV‐1) infection remains elusive. Chronic periodontitis (CP) is strongly associated with HIV‐1 infection. This condition is characterized by an intense inflammatory infiltrate mainly constituted of immune cells which in turn may be a valuable source of HIV‐1 reactivation. This study aimed to determine if gingival tissue could act as a reservoir for HIV‐1. Methods Twelve patients with HIV‐1 and CP and 12 controls (no HIV‐1‐infection and no CP) were evaluated in a cross‐sectional study. RNA viral load and interleukin (IL) levels were determined in blood plasma and saliva. Histological sections of gingival tissue were stained with fluorescent antibodies against p24 antigen and different cellular biomarkers. Results In six of the 12 patients, HIV RNA load was detected, despite cART; in three of them, expression of viral RNA was also detected in saliva. The levels of IL‐2, IL‐6, and IL‐12 were higher in blood and saliva of patients with HIVand CP than controls. HIV‐1 p24 antigen was detected by immunostaining in gingival biopsies of 10 of the 12 patients but in no controls. Immune markers for T cells and antigen‐presenting cells were also identified in most patients and some controls. Conclusion These preliminary data showing the detection of HIV‐1 p24 antigen in the gingival biopsies of a significant part of patients with HIV‐1 and CP under cART together with the presence of immune cells, plead for the existence of a HIV‐1 reservoir in the gingival tissue of this population.

Targeting HIV persistence in the tissue

“…Recent literature shows detection of viral DNA and/or RNA at multiple additional tissue sites [79], including hepatocytes and liver-infiltrating CD4 + T cells [80 ▪ ], lung bronchoalveolar lavage samples [81], hematopoietic progenitor cells in bone marrow [82,83], kidney [84], urethra [10,31 ▪▪ ], testicles [85] and prostate [3]. Further, inflammation at a particular site, such as the gingival tissue [86] or the CNS [15 ▪▪ ], may act as the spark that unmasks persistent reservoirs, likely in the form of antigen-specific CD4 + T RM that remained in a particular tissue to provide long-term memory. In this sense, application of ingenol mebutate to treat keratosis in ART-suppressed PWH can disrupt HIV latency in the skin tissue microenvironment in vivo [87].…”

Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors

“…The most frequent are types 6 and 11 [ 50 , 51 ]. Viral infections are also slightly related to periodontitis and gingival diseases [ 61 , 62 ].…”

Exposure to Biological Fluids in Dental Practice—Narrative Review on Appropriate Risk Assessment to Guide Post-Exposure Management

“…An additional important consideration is the fact that viral loads for HBV and HIV have been reported to be higher in the saliva of patients with periodontal disease [ 26 , 27 ], either through occult bleeding (reported to occur in 67% of patients with periodontal disease [ 27 ]) or through chronic inflammation and increased local endothelial permeability [ 28 ]. Furthermore, the gingival tissue has recently been added to the list of HIV reservoirs, at least in patients with marginal chronic periodontitis [ 26 ].…”