The burden of oral conditions among adolescents living with HIV at a clinic in Johannesburg, South Africa

Abstract

BackgroundThere are inconsistent reports on the prevalence of oral conditions and their associated factors among adolescents living with HIV (ALHIV). The current inconsistencies may hinder the development of clear guidelines on the prevention and treatment of oral conditions among ALHIV. This study provides an update on oral conditions and their associated factors in a cohort of South African ALHIV and receiving routine HIV treatment services at a Johannesburg HIV wellness clinic.MethodsDecayed Teeth (DT), Decayed Missing and Filled Teeth (DMFT) and Oral HIV/AIDS Research Alliance case definitions were used for caries examination and reporting of the Oral Mucosal Lesions (OML) respectively. Data analyses were stratified by the study main outcomes; chi-squared tests were performed to determine the associations; and multiple logistic regressions were also used to identify associated factors after adjusting for other exposure variables. In addition to fitting logistic regressions, we explored the data for potential confounders and effect modifiers.ResultsA total of 407 ALHIV were assessed, of which 51.0% were females. The mean age of the ALHIV was 14.75 years (SD 2.43) while the median age of their parents was 43 years (IQR 37–48 years). Regardless of sex, age group and other socio-demographic characteristics, participants had high count of dental caries (DMFT>0). The overall prevalence of dental caries was 56.76% (n = 231) with mean DT score of 2.0 (SD 2.48) and mean DMFT score of 2.65 (SD 3.01). Dental caries prevalence (DT>0) was significantly associated with the HIV clinical markers. HIV RNA viral loads more than 1000 copies/ml and CD4 cell counts less than 200 count cells/mm3, increased the likelihood of having dental decay among ALHIV (p<0.05). ALHIV at WHO staging III, IV had higher caries prevalence ranging from 70% to 75% (p<0.05). The prevalence of dental caries was directly related to the presence of oral mucosal lesions (p<0.05). The prevalence of OML was 22%, with linear gingival erythema (13.8%) accounting for most of the OML. Multiple logistic regression modelling suggested that dental caries experience (DMFT>0), age category 13–15 years, WHO staging of IV and viral load of more than 1000 copies/ml significantly predicted the outcome of oral lesions as assessed using the OHARA case definitions (p<0.05). The odds of developing dental caries was also 1.5 times more among ALHIV who brush their teeth less frequently and those who reported more frequent eating of sugar sweetened diets (p<0.05).ConclusionsThere is high prevalence of dental caries and OML among ALHIV in Johannesburg. The reported prevalence was associated with high HIV RNA viral loads, shorter duration on antiretroviral treatment and high WHO staging of HIV disease on crude analysis. Additionally, caries experience contributed to the prevalence of OML. Our study acknowledges the protective effect of HIV treatment and positive oral health practices on the presence of oral conditions among ALHIV in Johannesburg.

Oral Health Status of Young People Infected with HIV in High Epidemic Area of China

“…Study showed that dental caries was also 1.5 times more among adolescents living with HIV who brush their teeth less frequently. 24 Caries was lowest in HIV-positive children who brushed their teeth at least twice a day. 25 Different articles have reported varied prevalence of caries in children with HIV infection.…”

The Prevalence, Etiological Agents, Clinical Features, Treatment, and Diagnosis of HIV-Associated Oral Candidiasis in Pediatrics Across the World: A Systematic Review and Meta-Analysis

“…The prevalence of pseudomembranous candidiasis ranged from 1.7% in South Africa (56) to 72.2% in and Brazil (36). Also, the prevalence of angular cheilitis was highest in Indonesia, at 46.6% (3).…”

“…Among the 4,057 individuals, 468 (11.53%) did not receive HAART or ART. The data from 11 articles (28,33,43,44,48,49,(51)(52)(53)(54)56) demonstrated that HAART or ART were significantly associated with reduction in oral Candida colonization or infection, while others showed the opposite relationship (12,16,32,34,41,42,55), or did not report any statistical data (11, 14, 26, 35-40, 47, 50).…”

“…This confirmed the fact that these countries are those in which HIV is more widespread, especially among the pediatric population. Actually, Africa continent countries are home to about 15.2 percent of the world's population and more than two-thirds of the total HIV-infected patients worldwide are Africans (56). On the other hand, vertical transmission of HIV continues to be a largely uncontrolled problem in African countries where 95% of HIV-infected pregnant women live (57).…”

Epidemiology and Prevalence of Oral Candidiasis in HIV Patients From Chad in the Post-HAART Era

“…It is the most common yeast causing oropharyngeal candidiasis ( Schoofs et al, 1998 ), but other non- albicans Candida species have also emerged in this context ( De Bernardis et al, 1996 ; Powderly et al, 1998 ; Cartledge et al, 1999 ; Mushi et al, 2016 , 2018 ; Ambe et al, 2020 ). Colonization of oral mucosal surfaces with yeasts such as C. albicans is closely correlated to symptomatic disease (oropharyngeal and esophageal candidiasis; Pappas et al, 2003 ) and latter one with the severity of cellular immunodeficiency, especially infected hosts with the HI virus ( Mercante et al, 2006 ; Malele Kolisa et al, 2019 ). In a resource-poor setting without access to CD4 + T-cell counting and HIV viral load measurements, oral candidiasis is one of the most important clinical markers of HIV infection, disease progression, CD4 + T-cell status ( Fidel, 2006 ; Berberi et al, 2015 ), and can even give a hint to antiretroviral therapy failure ( Hodgson and Rachanis, 2002 ; Ramirez-Amador et al, 2007 ).…”