Impact of periodontal intervention on local inflammation, periodontitis, and HIV outcomes

Abstract

Objective Periodontal disease resolution was hypothesized to impact systemic HIV measures. Methods In this longitudinal cohort study, 73 HIV-positive subjects received comprehensive dental care. AAP, CDC/AAP and biofilm gingival interface case definitions determined periodontal classification. In a subset, IL-6 was measured. Multivariable binary logistic regression models estimated odds of periodontitis development for comparisons between HIV and NHANES (2009–12) groups. Results In both groups, moderate/severe periodontitis was positively associated with non-white race, smoking, male gender, low income and increased pro-inflammatory cytokines. Likelihood of HIV periodontitis was higher across demographic variables. Subjects with severe periodontitis on antiretroviral therapy demonstrated high plasma viral loads at baseline (median= 464 co/ml; mean 65,773 co/ml). Post intervention, HIV periodontitis distribution became similar to NHANES and IL-6 levels decreased 2-fold (p=0.07). Subjects with suppressed viral load at baseline demonstrated increased CD4 counts at 12 months post intervention (P=0.027) (n=26). Conclusions Smoking, being non-white and low income were associated with periodontitis in HIV and NHANES. Higher Il-6, higher HIV VL and lower CD4 were associated with moderate/severe periodontal disease. Periodontitis decreased significantly with treatment producing periodontal profiles mirroring the national norm. In a subset of suppressed subjects, decreased oral inflammation, and associated microbial translocation, yielded improved CD4 counts.

Effects of non‐surgical periodontal therapy on clinical and immunological profile and oral colonization of Candida spp in HIV‐infected patients with chronic periodontitis

“…31 With respect to immunological parameters of HIV infection, although the findings do not rule out the possibility that ART was responsible for a significant increase in the CD4+ T lymphocyte counts and a decrease in plasma viral load, our results suggest that NSPT (via oral cavity decontamination, and consequent reduction of inflammation) had a beneficial impact on HIV infection control. Similar results were reported by Noro-Filho et al 32 and Valentine et al, 33 which suggests that periodontal inflammation affects the production of systemic inflammatory markers, and that the presence of periodontal pathogens and their toxic products impairs viral suppression and induces HIV reactivation. Moreover, the decrease in viral load may also be a result of the impact of NSPT on the oral microbiota.…”

“…Similar results were reported by Noro‐Filho et al . and Valentine et al., which suggests that periodontal inflammation affects the production of systemic inflammatory markers, and that the presence of periodontal pathogens and their toxic products impairs viral suppression and induces HIV reactivation. Moreover, the decrease in viral load may also be a result of the impact of NSPT on the oral microbiota.…”

“…The proinflammatory cytokines IL‐6, IL‐8, and TNF‐α have been shown to exert various immunological functions, including regulation of the inflammatory response and cancer development . In the present study there was a trend of decrease in salivary IL‐6 concentrations after NSPT in both groups, as demonstrated by Valentine et al., who reported a decrease in salivary IL‐6 levels after periodontal therapy in HIV‐patients with CP. Salivary IL‐8 concentrations decreased after NSPT over the study in both groups.…”

In Defense of Flossing: Part II-Can We Agree It's Premature to Claim Flossing Is Ineffective to Help Prevent Periodontal Diseases?

“…The BGI clinical categories are clearly different from the more established or “traditional” definitions of periodontitis that focus on clinical attachment loss (CAL)—perhaps because it was developed with an intent of examining a periodontal-systemic link. Recently, a longitudinal intervention study by using an HIV+ cohort found that biologically-based BGI classification differentiated baseline profiles of PD and changes over time in levels of PD 30 better than traditional measures such as the American Academy of Periodontology (AAP) 26 and the Centers for Disease Control with the American Academy of Periodontology (CDC/AAP) 31 which focus on CAL. Such results suggest that the BGI system may have utility in longitudinal studies of flossing/interproximal cleaning.…”

Prevalence of dental symptoms and access to dental care in an American HIV outpatient clinic

“…As discussed in your supplement, dental disease has widespread health impacts on nutrition, immune activation, and inflammation and has been associated with increased rates of cardiovascular disease (John, 2016). Treatment of periodontal disease can reduce systemic inflammation, increase CD4+ T-cell counts in HIVpositive individuals (Valentine et al, 2016), and improve endothelial function and reduce cardiovascular risk (Tonetti et al, 2007). Thus, identifying individuals with the oral disease and facilitating access to dental care is likely to have broad benefits for people living with HIV.…”