HIV infection and periodontal diseases: an overview of the post‐HAART era

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.

Short-Chain Fatty Acids from Periodontal Pathogens Suppress Histone Deacetylases, EZH2, and SUV39H1 To Promote Kaposi's Sarcoma-Associated Herpesvirus Replication

“…Higher prevalence of periodontal disease has been observed in HIV patients (4,5). The symptoms of periodontal disease in HIV patients are very distinctive and more severe (6).…”

“…However, it remains unclear why oral KS occurs only in a subset of patients. Clinically, it has been noticed that HIV patients display a higher prevalence of periodontal disease with more severe symptoms (4)(5)(6). Accumulating evidence supports the notion that periodontal disease creates an oral microenvironment that stimulates KSHV replication and infection, contributing to oral KS development.…”

Suppression of Transforming Growth Factor β Receptor 2 and Smad5 Is Associated with High Levels of MicroRNA miR-155 in the Oral Mucosa during Chronic Simian Immunodeficiency Virus Infection

“…characterized by a significant increase in generalized immune activation (1,2) and in mucosal inflammatory conditions such as periodontitis and gingivitis (3)(4)(5)(6). Some studies have reported an increased migration of inflammatory cells into the oral mucosa (7), whereas others have shown that levels of proinflammatory cytokines such as interleukin-6 (IL-6) (8-10) were significantly elevated during HIV infection.…”

The oral microbiome in human immunodeficiency virus (HIV)-positive individuals

“…Oral candidiasis is a particularly common problem in HIV-infected individuals, although the introduction of HAART has led to a decline in its incidence (Hodgson et al, 2006). Infection with HIV is also associated with the periodontal diseases: linear gingival erythema, nectrotizing ulcerative gingivitis (NUG) and acute necrotizing periodontitis (ANP) (Mataftsi et al, 2011). NUG and ANP typically have a sudden onset and can cause severe pain.…”