Sensitivity and Specificity of Linear Gingival Erythema as Immune Suppression Marker in Pediatric HIV-infected at UPIPI Soetomo General Hospital Surabaya, Indonesia

Abstract

Introduction: Strikingly, more than 95% pediatric HIV infections worldwide are in developing countries.Although ART can reduce significantly the risk of HIV transmission to children born from HIV-infected mothers, this can be effective only if the women know their HIV status. In many developing countries, such as Indonesia, the lack of access by pregnant mothers to laboratory facilities may deprive them of knowing their HIV status, thus the opportunity to transmit the disease to their children is high, knowing no preventive intervention is attempted. To date, it is estimated that the number of HIV infected children in Indonesia who are left undiagnosed is still high, therefore a study on clinical markers of HIV that can aid in the diagnosis and predict the severity of the disease among children is critical. In this study, Linear Gingival Erythema is assessed on its correlation to degree of immune suppression to be used as HIV clinical marker in laboratorypoor settings in Indonesia. Method: HIV-infected children admitted to Soetomo General Hospital between June -October 2017 were screened and examined intraorally for the presence of LGE. Other relevant data were obtained from questionnaire-guided interview to parents/guardians and from patient's medical record. Results:LGE was found in 21.43% children and statistical analysis shows significant correlation of LGE to degree of immune suppression. Conclusion: Further study with larger study population size is required to analyze the sensitivity and specificity of LGE to be used as HIV marker in predicting a particular degree of immune suppression, specific to Indonesian pediatric population.

Correlation of Low CD4+ Counts with High Dental Caries Prevalence in Children Living with Perinatal HIV/AIDS Undergoing Antiretroviral Therapy

“…CD4 + counts were an important marker to predict immunosuppression status during HIV/AIDS progression in CLWPHA [3,5,28]. Low CD4 + counts were found in this study, and it is correlated with high dental caries prevalence in CLWPHA.…”

“…Estimated only half of PWLWHA 56% from 61.000 who gave birth in the Asia Pacific region got effective ARV prophylaxis. In addition, only 25% of HIV-exposed infants received early diagnosis [3][4][5][6][7]. The number of Children Living with Perinatal HIV/AIDS (CLWPHA) have greatly increased with more than 230% increase since 2010 [3,7].…”

Impact of Antiretroviral Therapy on Oral Health among Children Living with HIV: A Systematic Review and Meta-Analysis

“…Table 1 reports the characteristics of the 14 included studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36]. A total of 3525 CLWH and adolescents, aged from three months to 17 years, were recruited from hospitals and AIDS outpatient centres in India, Brazil, and several Asian countries.…”

Ellagic acid: an alternative for antifungal drugs resistance in HIV/AIDS patients with oropharyngeal candidiasis

“…The infection can indirectly affect the innate immunity through microbial translation, inflammation, and immune activation, whereas immune activation reduce the number of monocytes, natural killer (NK), and innate lymphoid cells (ILCs), which consequently leads to occurs due to immunodeficiency condition. Oral microbiome turns to opportunistic pathogens that can lead to oral manifestations closely related to HIV/AIDS, such as oral candidiasis (OC) [3,6], oral hairy leukoplakia (OHL) [7,8], linear gingival erythema (LGE) [4,9], necrotizing ulcerative gingivitis (NUG), and necrotizing ulcerative periodontitis (NUP) [10]. In addition, through the HIV/AIDS onset, the use of antiretroviral therapy (ART) and psychological stress can trigger xerostomia in PLWHA [11,12].…”

“…In 2017, East Java was one of the provinces in Indonesia, which was rated the second highest HIV/AIDS prevalence, with nearly 39,633 PLWHA [3]. The trend of AIDS-related mortality is declining in almost all high-risk countries, but Indonesia is an exception [4]. In Indonesia, there are some provinces with a significant growth rate of HIV/AIDS cases.…”