Effect of Nadir CD4+ T Cell Count on Clinical Measures of Periodontal Disease in HIV+ Adults before and during Immune Reconstitution on HAART

Abstract

BackgroundThe contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD.MethodsWe performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥1 site with periodontal probing depth (PPD) ≥5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥4.0mm, and bleeding on probing (BOP) at ≥4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD.ResultsForty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD.ConclusionDegree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.

Statistical Analysis of CD4+ Cell Counts progression of HIV-1-positive Patients enrolled in Antiretroviral Therapy at Hossana District Queen Elleni Mohamad Memorial Hospital, South Ethiopia

“…The data was unbalanced because some subjects were not keeping the regular time schedule and they were measured at different time points and the number of measurements was different across a subject which is similar to Vernon et al, 7 The time scale was used in a monthly format though a six months interval schedule was not worked for some patients which might be reluctance of subjects to follow up. The data was analyzed by version SAS 9.2 using PROC NLMIXED procedure that fits nonlinear mixed models-that is, models in which both fixed and random effects enter nonlinearly.…”

Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report

“…Likewise, other studies support the association between reduced CD4 count and increased gingival recession and/or clinical attachment loss (Robinson et al , ; McKaig et al , ; Alves et al , ). A recent study by Aichelmann‐Reidy et al (), did not support this association (Aichelmann‐Reidy et al , ); however, this group did not report nadir CD4 count, a critical variable linking HIV to PD (Vernon et al , ). Overall, ART appears to minimize the detrimental effects of HIV on PD; however, the long‐term effects (i.e., >5–10 years) resulting from pre‐ART‐associated gingival recession (Robinson et al , ; McKaig et al , ; Alves et al , ; Vernon et al , , ) on PD progression and tooth loss are not known.…”

“…Direct clinical effects of HIV on teeth are largely unknown; however, HIV (Nittayananta et al, 2010a) and/or ART-associated xerostomia (Nittayananta et al, 2010c) could increase the risk for dental caries (Ram et al, 2011). Further, it is presently unknown whether immunosuppression-associated gingival recession (Robinson et al, 1996;McKaig et al, 1998;Alves et al, 2006;Vernon et al, 2009Vernon et al, , 2013 (especially when coupled with xerostomia) could increase the long-term risk for root caries and/ or tooth loss.…”

“…The reported increase in the prevalence of oral warts during the ART era is controversial: results have varied across time and geographical setting with few recent longitudinal studies examining human papillomavirus (HPV)‐subtypes (Patton et al , ). Long‐term prospective studies using standardized methodology (Patton et al , ) are needed: investigating behaviors which can transfer microorganisms between oral/oropharyngeal and genital surfaces (D'Souza et al , , ) and assessing the relationship to critical immunological variables [i.e., the cohort's immunological framework (Vernon et al , , )] may clarify this topic. The interaction of HIV with oncogenic HPVs is discussed under Question 4.…”

“…[2.2.] Exposure to HIV‐related immunosuppression (i.e., a low nadir CD4 count) can strongly influence risk for adverse clinical outcomes including CVD (Hsue et al , ; Ho et al , ), low BMD (osteopenia) (Barkhordarian et al , ; Ofotokun and Weitzmann, ) and PD (Vernon et al , , ; Pattrapornnan and DeRouen, ). In a cross‐sectional study of 112 HIV+ adults in the USA, Vernon et al () found that a CD4 count <200 cells μ l −1 had nearly twice the (negative) effect on clinical attachment level ( P < 0.001) than did smoking, a well‐established risk factor for PD (Vernon et al , ).…”