The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth

Abstract

ObjectiveTo compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU).MethodsIn a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models.ResultsEleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment.ConclusionsOral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions.

Biomarkers of oral inflammation in perinatally HIV‐infected and perinatally HIV‐exposed, uninfected youth

“…Patients were recruited from the Adolescent Master Protocol (AMP) of PHACS, which is a prospective cohort study designed to determine the impact of HIV infection and ART on PHIV youth and includes a comparison group of PHEU youth. The design of the study and eligibility criteria have been defined in several publications (Alperen et al, ; Moscicki et al, ; Van Dyke et al, ). The OHS protocol (Moscicki et al, ; Ryder, Yao, Russell, Moscicki, & Shiboski, ) was a cross‐sectional substudy within AMP with a single visit per subject.…”

“…Data collection in the PHACS OHS, including a full‐mouth examination and assessment of clinical gingival inflammation, probing depths and clinical attachment loss is detailed elsewhere (Moscicki et al, ). Briefly, sites scheduled a comprehensive OHS visit within 3 months of a regularly scheduled AMP annual visit.…”

Current trends and new developments in HIV research and periodontal diseases

“…In this study, the prevalence of periodontal disease did not differ between perinatally HIV‐infected children and adolescents and perinatally HIV‐exposed uninfected children and adolescents, with 32% of this population having mild or moderate periodontitis, as defined by the modified United States Centers for Disease Control and Prevention classification system. However, using the same classification system, lower prevalence (22%) was reported in the Nutrition Examination Survey of an older general population aged 30‐34 years . Among children living with HIV, a younger age of first exposure to combined antiretroviral therapies was associated with fewer teeth with bleeding on probing at multiple sites .…”

“…In addition, there is an opportunity to compare the development of this oral microbiome with children and youth under similar beneficial or detrimental environmental conditions . For example, in the recent cross‐sectional multicenter study on HIV and oral health in both perinatally HIV‐infected and perinatally HIV‐exposed uninfected youth, no significant differences in the oral microbiome were noted, with some exceptions, for instance, lower levels of Corynebacterium and Streptococcus mutans among perinatally HIV‐infected youth. As Corynebacterium is considered one of the health‐associated taxa in plaque, this may be one possible contributing factor in the higher caries prevalence in perinatally HIV‐infected youth, as was observed in one study .…”

The Kidney and Periodontal Disease (KAPD) study: A pilot randomized controlled trial testing the effect of non-surgical periodontal therapy on chronic kidney disease

“…A minimum concurrence of 90% for surfaces with or without caries, PD, and GM position was required. If this level of concurrence was not achieved, the calibrator would review these techniques and conduct a second calibration on another patient until this minimal concurrence was met [20]. There was 97.6–100% concurrence of probing depth assessments within ±1 mm and 96.4–100% concurrence of gingival margins within ±1 mm between calibrator and examiners.…”