The child and adolescent with HIV in resource poor countries

Abstract

Although sub-Saharan Africa caries the burden of paediatric and adult HIV/AIDS infections, the epidemic is spreading most rapidly in the Middle East and North Africa Region where between 2005 and 2013, AIDSrelated deaths increased by 66% in comparison with a worldwide fall of 35%. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54%; yet only 28% of children have access to HIV treatment. This review sought to provide an update of paediatric and adolescent oral HIV/AIDS issues in resource poor countries. OBJECTIVES: To review the literature on paediatric & adolescent HIV with a focus on oral lesions as predictors of HIV infection; as markers of the efficacy of HAART and quality of life; caries risk; management of oral lesions; and epidemiological tests for clinical significance of oral lesions. METHODS: A search strategy was developed for PubMed to identify papers on paediatric oral HIV. Publications in English were selected on the basis that their titles and abstracts were relevant to the review objectives. The reference lists of included papers were screened for additional articles. The time-search for publications was limited from 2009 to 15 October 2014. RESULTS: Papers on the prevalence of oral lesions lacked standardization in diagnostic criteria and the introduction of HAART had significantly reduced prevalence; oral lesions remain useful predictors for HIV infection and as markers for the efficacy of HAART.Evidence suggest that caries risk is increased with HIV infection; management of oral lesions is inconsistent with available resources and surprisingly little recent information has been published in the past 5 years. Revised case definitions are proposed for large-scale epidemiologic studies with the development of an oral lesion index showing promise. Oral health quality of life indicators for children and adolescents are becoming important as more of these indicators are being developed and their negative oral impacts in individuals with oral lesions are now well established. CONCLUSIONS: Paediatric and adolescent oral HIV research needs to be prioritized as current studies are few and are characterized by poor quality study designs, small study samples and a lack of multicentre collaborations. There is a lack of high quality evidence for a number of interventions available for management of oral lesions. Oral Diseases (2016) 22, 25-34

Considerations in the oral care of HIV+/AIDS pregnant adolescents.

“…4 However, viral reappearance with drug-resistant microorganisms is an emergent phenomenon. This phase of failing HAART is when the HIV load increases the transmission of drug-resistant HIV to vulnerable patients.…”

“…If proper precautions are not taken while administering antiretroviral drugs, pregnant adolescent patients may develop oral and systemic side effects such as anemia, hepatotoxicity, preterm delivery, pre-eclampsia, lipodystrophy, mitochondrial toxicity, glucose intolerance, erythema multiforme, congenital abnormalities, hyperpigmentation, cheilitis, ulcers, perioral paresthesia, and others. 4 Moreover, oral manifestations are very important early indicators of an HIV infection. There are three groups of early oral manifestations of AIDS: the first group includes oral candidosis (erythematous, pseudomembranous, angular cheilitis), herpes simplex virus infection, linear gingival, parotid enlargement, recurrent aphthous ulcers; the second group involves viral infections (cytomegalovirus, papillomavirus, herpes zoster virus, molluscum contangiosum, herpes simplex virus), erythema necrotizing ulcerative gingivitis, hairy leukoplakia and necrotizing ulcerative periodontitis, unusual ulcers and salivary glands illness; and finally, the third group is characterized by osteomyelitis, tuberculosis-related ulcers, squamous cell carcinoma and Kaposi sarcoma.…”

“…Oral health is strongly connected with physical and emotional health, and there are important increases in oral health needs in HIV+/AIDS individuals, especially during pregnancy. The current literature available [2][3][4][5] has limited information regarding the above-mentioned specific patient group. We suggest a deep and thorough analysis, as well as the development of specific guidelines to provide the targeted population with proper oral health care.…”

Craniofacial morphology of HIV-positive children and adolescents undergoing antiretroviral therapy: A pilot study

“…Conclusions: These results led us to conclude that some cephalometric measurements of HIV-positive children and adolescents may be similar to those of normoreactive subjects. (Am J Orthod Dentofacial Orthop 2018;153: [26][27][28][29][30][31][32][33][34][35] W ith the implementation of highly active antiretroviral therapy (HAART) in the 1990s, patients with human immunodeficiency virus (HIV1) experienced a significant increase in their quality and expectation of life. But in a short while, the adverse effects of the combination of antiretroviral drugs began to be identified through the compromised physiologic functions in several systems and organs.…”

“…Recent studies have pointed out that there are few studies about children and adolescents with HIV, and particularly about the adverse effects of HAART on this population. 32,33 At the 7th World Workshop on Oral health and Disease in AIDS, the researchers identified the need for better knowledge about the orofacial health problems of HIV1 children. 33 In agreement with the most recent concerns raised in this area of research, the aims of this study were to analyze the craniofacial morphology by evaluating the skeletal cephalometric profile of HIV1 patients, all infected by vertical transmission and submitted to antiretroviral therapy and to compare them with normoreactive patients.…”