The Oral HIV/AIDS Research Alliance Program: lessons learned and future directions

Abstract

The Oral HIV/AIDS Research Alliance (OHARA) was established in 2006 to provide the capacity to investigate the oral complications associated with HIV/AIDS within the ACTG infrastructure. Its goals were to explore the effects of potent antiretroviral therapy (ART) on the development of opportunistic infections, and variation and resistance of opportunistic pathogens in the context of immune suppression and long-term ART. The objectives of this talk, presented as part of a plenary session at the 7th World Workshop on Oral Health and Disease in AIDS, were to (i) provide an overview of OHARA's most recent research agenda, and how it evolved since OHARA's inception; (ii) describe OHARA's main accomplishments, including examples of research protocols completed and their key findings; and (iii) describe spin-off projects derived from OHARA, lessons learned, and future directions. OHARA has met its central goal and made key contributions to the field in several ways: (i) by developing/updating diagnostic criteria for oral disease endpoints commonly measured in OHARA protocols and in HIV/ AIDS research in general and has creating standardized training modules, both for measuring these oral disease endpoints across clinical specialties, and for collecting oral fluid specimens; (ii) by implementing a total of nine protocols, six of which are completed. Three protocols involved domestic research sites, while three involved international research sites (in Africa, India, and South America); (iii) and by developing and validating a number of laboratory assays used in its protocols and in the field of oral HIV/AIDS research. Oral Diseases (2016) 22, 128-134

Common oral opportunistic infections in Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome: Changing epidemiology; diagnostic criteria and methods; management protocols

“…It has also been reported in cohorts on HAART regimens . In resource‐poor settings it is established that there is a strong association between OC and tuberculosis disease, and this finding suggests that OC may provide clinical evidence for increased risk of tuberculosis and contribute to early tuberculosis identification …”

“…The case definitions proposed were structured and meant for use in large‐scale epidemiological studies across the world in both developed and developing countries, by dental and nondental health care providers. The important contribution of OHARA is the development of standardized training modules for measuring oral disease end points …”

Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention

“…However, there are many patientspecific factors that potentially influence the general framework of prevention (e.g., antibiotic prophylaxis prior to prevention measures). ese include an infectious risk for endocarditis (e.g., heart valve replacement and history of endocarditis) or other systemic infectious complications in immunocompromised patients after organ transplantation, patients experiencing immunosuppression due to autoimmune disease (e.g., rheumatoid arthritis), patients undergoing dialysis, and patients with insufficiently controlled diabetes mellitus or infectious diseases, , e.g., HIV/AIDS [11,26,31,[63][64][65]. Furthermore, the content of prevention must be adapted based on the patient's risk of complications.…”

“…However, the risk factors for oral diseases are more multifarious and complex. Rheumatic diseases [21,22], osteoporosis [68], renal insufficiency [69], radiation therapy [70], infectious diseases [63], and many medications causing oral side effects [33,34] can affect the occurrence of caries and/or periodontitis. A problem of growing importance is the worldwide increase in obesity, which has a clinically relevant relation to periodontal inflammation; obese patients have special needs regarding dental care within a multidisciplinary concept [71].…”

An Appreciation of a Giant in Orofacial Sciences Research—John Greenspan

“…The workshops have had worldwide impact, leading to robust research agendas, changes in national HIV policies, and international collaborations ( Greenspan and Challacombe 2020 ). Identification of research needs led to adoption of a research agenda by NIDCR and by the Oral HIV/AIDS Research Alliance (OHARA) linked to the NIH/National Institute of Allergy and Infectious Diseases–funded AIDS clinical trials group network ( Shiboski et al 2011 , 2016 ). Evidence-based declarations from the workshops have led to policies regarding access to oral care as a basic human right for both HIV-positive and HIV-negative individuals and advancing the rights of HIV-positive health care workers to perform clinical practice.…”