Global oral inequalities inHIVinfection

Abstract

Analysis of the prevalence and incidence of HIV infection globally reveal striking variances with regard to continent, country, region and gender. Of the global total of 33 million people infected with HIV, approximately 65% are in sub‐Saharan African countries and 15% in South and South‐East Asia with the remaining 20% spread over the rest of the world. As a percentage of the population, the Caribbean at 1.1% is second only to sub‐Saharan Africa (5.5%). The majority of the world's HIV is in women. Deaths from HIV are twenty‐fold greater in Africa than in Europe or the USA. Individual countries in sub‐Saharan Africa show huge variances in the HIV+ prevalence with most West African countries having a rate of less than 2% whilst southern African countries including Swaziland and Botswana have rates of around 25%. Environment, education and social habits all contribute to the HIV infection rates. Similar variations between countries are seen in SE Asia with Cambodia and Papua New Guinea having rates three times greater than Pakistan. One of the most striking examples of inequality is in life years added to HIV populations as a result of antiretroviral therapy. UN AIDS figures over 1996–2008 suggest an average of 2.88 added years in the USA and Europe, but only 0.1 in sub‐Saharan Africa, a thirty‐fold difference largely due to accessibility to ART. ART leads to a reduction in oral lesions but it is estimated that some 10 million HIV+ subjects do not have access to oral care. Thus, inequalities exist both for HIV infection and for the associated oral lesions, mainly related to ART access. HIV infection and oral mucosal lesions both appear to be related to general social determinants of health. Oral HCW must be part of mainstream healthcare teams to address these inequalities.

Oral Manifestations in HIV-Positive Children: A Systematic Review

“…The prevalence of HIV-related oral manifestations is estimated to be in a range between 30% and 80%: This value increases when the CD4+ T-cell count is low (<200 cell/mm3) and the viral load is high (>20,000 copies/mL) [24]. Furthermore, the prevalence of oral lesions is greater in developing countries because of late diagnosis and difficult access to treatment [25,26].…”

“It was pain. That’s it. It was pain.” Lack of oral health care among otherwise healthy young adults living with HIV in South Africa: A qualitative study

“…For example, if a physician upon oropharyngeal exam notes severely decayed teeth, he or she should refer to the appropriate public dental clinic for care. Similarly, dentists can use very simple diagnostics, such as taking blood pressure, to screen for chronic diseases such as hypertension, HIV, and/or diabetes and refer for management [ 10 , 11 , 31 , 32 ]. Colocation of medical and dental professionals would allow patients who arrive with an oral health complaint to be treated on site [ 33 ].…”

“…Furthermore, reports suggest a high level of untreated caries among all age groups, a high prevalence of missing teeth among the adult population and extraction the most common dental treatment available for South Africans [ 9 , 10 ]. South African populations that suffer from high prevalence of infectious diseases such as HIV/AIDS, often also suffer high burden of dental disease, which may be exacerbated by inequality in access to care [ 11 , 12 ].…”

Caries experience by socio-behavioral characteristics in HIV-1 infected and uninfected Ugandan mothers - a multilevel analysis

“…Following widespread implementation of highly active anti-retroviral drugs (HAART), studies have shown an increase in life expectancy as well as in the prevalence of HIV-1 infected people worldwide [1]. Sub Saharan African countries are currently contributing 65% to the global total of 33 million people living with HIV [2]. Although people with HIV-1 are particularly vulnerable to oral diseases, studies examining their dental caries experience have so far been rare [3].…”