SummaryBackgroundThe length of time that people with HIV on antiretroviral therapy (ART) with viral load suppression will be able to continue before developing viral rebound is unknown. We aimed to investigate the rate of first viral rebound in people that have achieved initial suppression with ART, to determine factors associated with viral rebound, and to use these estimates to predict long-term durability of viral suppression.MethodsThe UK Collaborative HIV Cohort (UK CHIC) Study is an ongoing multicentre cohort study that brings together in a standardised format data on people with HIV attending clinics around the UK. We included participants who started ART with three or more drugs and who had achieved viral suppression (≤50 copies per mL) by 9 months after the start of ART (baseline). Viral rebound was defined as the first single viral load of more than 200 copies per mL or treatment interruption (for ≥1 month). We investigated factors associated with viral rebound with Poisson regression. These results were used to calculate the rate of viral rebound according to several key factors, including age, calendar year at start of ART, and time since baseline.ResultsOf the 16 101 people included, 4519 had a first viral rebound over 58 038 person-years (7·8 per 100 person-years, 95% CI 7·6–8·0). Of the 4519 viral rebounds, 3105 (69%) were defined by measurement of a single viral load of more than 200 copies per mL, and 1414 (31%) by a documented treatment interruption. The rate of first viral rebound declined substantially over time until 7 years from baseline. The other factors associated with viral rebound were current age at follow-up and calendar year at ART initiation (p<0·0001) and HIV risk group (p<0·0001); higher pre-ART CD4 count (p=0·0008) and pre-ART viral load (p=0·0003) were associated with viral rebound in the multivariate analysis only. For 1322 (29%) of the 3105 people with observed viral rebound, the next viral load value after rebound was 50 copies per mL or less with no regimen change. For HIV-positive men who have sex with men, our estimates suggest that the probability of first viral rebound reaches a plateau of 1·4% per year after 45 years of age, and 1·0% when accounting for the fact that 29% of viral rebounds are temporary elevations.InterpretationA substantial proportion of people on ART will not have viral rebound over their lifetime, which has implications for people with HIV and the planning of future drug development.FundingUK Medical Research Council.

In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue through out the lifespan.

acted as a barrier, inhibiting fl uoride uptake and consequently reducing the clinical efficacy of the topical fl uoride application. 2,3 Many clinicians believe that the removal of the acquired pellicle, plaque and other substances adhering to the enamel by professionally applied prophylaxis results in a greater amount of fl uoride contacting the enamel surface, thus enhancing the efficacy of a PATF, 2,4 and an expected increase in the reduction in the incidence of caries. The removal of plaque can be effectively accomplished with a toothbrush. However, the belief is that the acquired pellicle, a thin organic layer adherent to the surface enamel, can only be removed by pumice or other abrasive prophylaxis. 2 The role of bacterial dental plaque in the aetiology of gingivitis and periodontal disease has been well established. 5 Part of the prevention of such conditions is based on limiting the accumulation of micro-organisms on the teeth and maintaining a fl ora that is consistent with periodontal health.Three separate studies have evaluated the effect of dental prophylaxis before PATF on the amount of fl uoride uptake by BACKGROUNDDental prophylaxis typically consists of placing pumice or an abrasive paste in a rubber cup and applying the paste to the clinical crowns of the teeth using rotating rubber cup at slow speed. This aims at the complete removal of plaque, salivary pellicle, materia alba and extrinsic stains found on the crowns of teeth to reduce and prevent future dental caries. The clinical protocol for performing a routine dental prophylaxis before professionally applied topical fl uoride (PATF) was fi rst advanced by Knutson. 1 The rationale behind this was the belief that materia alba, plaque and other natural coatings on tooth surfaces Background The purpose of this systematic review was to assess the effi cacy of routine dental prophylaxis applied before professionally applied topical fl uoride (PATF) or at a regular recall visit in the prevention of caries or gingivitis. Types of studies reviewed Ovid MEDLINE and its allied versions; CINAHL; Cochrane Library; EMBASE; Health and Psychosocial Instruments; HealthSTAR; International Pharmaceutical Abstracts; and ACP Journal Club were searched for English and Human articles from 1966 to 2007 for original in vivo English publications assessing rubber cup dental prophylaxis. In vitro studies, case series, case reports or letters to editors (not containing primary data), editorials, review articles and commentaries were excluded but were read to identify any potential studies. Results One hundred and eighty-nine articles were searched for relevancy resulting in six original studies that met our inclusion criteria. There was a unanimous agreement in four studies that a dental prophylaxis is not warranted before a PATF for caries prevention in children. A generalisation on dental prophylaxis before PATF cannot be applied to adolescents and adults. Available evidence (two other studies) fails to demonstrate any benefi t in the prevention of gingivitis from ...

The City of North York Public Health Department (NYPHD) operates a school-based dental programme that provides preventive and treatment services to children according to evidence-based practice guidelines. This programme and private dental practices (PDP) represent the only sources of dental care for children in North York. The purpose of our study was to compare the oral health and family characteristics of clients from the NYPHD and PDP using a dental examination and a parent interview. Results showed that NYPHD and PDP clients had similar levels of fluorosis, calculus, and periodontal health, but NYPHD clients had experienced greater levels of decay. Clients of the NYPHD and PDP also had significantly different family characteristics, many of which were significantly associated with the presence of one or more decayed primary or permanent teeth. Multivariate logistic regression identified mother's immigration history, past caries experience, and parents' rationale for scheduling their child's dental appointments as the principle risk makers for dental decay. When compared with PDP clients, the NYPHD serves higher-needs children who otherwise might not receive care.