Is human immunodeficiency virus (HIV) stage an independent risk factor for altering the periodontal status of HIV-positive patients? A South African study

Abstract

BackgroundThe immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The aim of the study was to establish whether HIV stage (as depicted by CD4+ T lymphocyte counts) could independently be associated with periodontal status (as revealed by the measurement of clinical indices).MethodsOne hundred and twenty HIV-infected patients attending an infectious diseases clinic in the Western Cape, South Africa were included in the study. The periodontal clinical indices such as plaque index, gingival index, pocket probing depth and clinical attachment levels were measured on the mesial aspect of the six Ramfjord teeth. The CD4 + T cell counts were taken from the patients’ medical records and patients’ HIV stage determined and grouped according to their CD4+ T cell counts into A (<200 cells /mm3), B (200–500 cells /mm3) and C (>500 cells /mm3).ResultsThe mean age of 120 HIV-positive patients was 33.25 years and the mean CD4 + T cell count was 293.43 cells/mm3. The probing depth and clinical attachment loss were found to be significantly associated with the total CD4 + T cell counts but not with HIV stage. Significant correlations were found between age and all clinical indices except for clinical attachment loss. No correlation was found between age and HIV stage of the patients. The use of antiretroviral therapy was significantly associated with probing depth and clinical attachment loss, but not with plaque nor gingival index. Significant associations were observed between smoking and all of the clinical indices except for the gingival index. A significant association was observed between the use of interdental aids and all the clinical indices except for probing depth, while brushing was significantly associated with plaque index only. CD4 + T cell counts were significantly associated with brushing frequency (p = 0.0190) and the use of interdental aids (p = 0.0170).ConclusionThe findings of this study conclude that HIV stage, ART and age are not independent risk factors for changes in the periodontal status of HIV-positive subjects but rather that smoking and oral hygiene habits determine their susceptibility to disease.

Increased expression of CD38 and HLADR in HIV‐infected patients with oral lesion

“…Our study has also shown the association of oral lesion with low CD4 + /CD8 + ratio ( P = 0.03). Another study has showed association between CD4 + T cell counts and periodontal disease in HIV‐infected patients, independent of HIV stage . Immunohistologic evaluation of gingival biopsies in HIV‐positive and HIV‐negative patients, presenting with periodontal disease, showed a decrease of CD4 + T cells counts and of CD4 + /CD8 + T cells ratio in the gingival connective tissue of HIV positive individuals …”

Impact of periodontal intervention on local inflammation, periodontitis, and HIV outcomes

“…Our findings were similar to the findings of John et al in a South African population where HIV stage and ART were not associated with higher levels of periodontal disease in HIV‐positive subjects. In the South African group inclusion of a gingival index of inflammation reversed the significant association between antiretroviral therapy, probing depth and clinical attachment loss, (John et al , ). Of all classification systems, BGI, the inflammation‐based classification system, demonstrated the most significant shifts in category associated with the dental intervention, moving virtually all individuals of the severe category into a moderate disease group by 12 months.…”

Oral microbiome in HIV-associated periodontitis

“…The determinants, course, and impact on other comorbid conditions of severe PD in the setting of ART remain a matter of controversy. [3,4] …”