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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1470-1473  

Assessment of oral health and prevalence of oral conditions in human immunodeficiency virus-infected subjects visiting antiretroviral therapy centers


1 Senior Resident, Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Oral Medicine and Radiology, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India
3 Reader, Department of oral medicine and radiology, Buddha Institute Of Dental Sciences And Hospital, Patna, Bihar, India
4 Department of Periodontics, Dental Officer, ECHS Polyclinic, Ministry of Defence, Hajipur, Vaishali, Bihar, india, India
5 Department Of Conservative Dentistry And Endodontics, Himachal Institute Of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
6 Department of Microbiology, Himachal institute of dental sciences, Paonta sahib, Himachal Pradesh, India
7 Associate professor, Department of Dentistry, Sri Shankaracharya Medical College, Bhilai, Durg Chhattisgarh, India

Date of Submission26-Mar-2021
Date of Decision12-Apr-2021
Date of Acceptance09-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Hitesh Gupta
Professor, Department of Conservative Dentistry and Endodontics, Himachal Institute of Dental Science, Paonta Sahib, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_256_21

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   Abstract 


Background: Weakened immune system from acquired immunodeficiency syndrome (AIDS) makes the individual prone to various opportunistic infections which are life-threatening including various carcinomas and disorders affecting the neurological system. Aims: The present trial was done to assess the prevalence of oral presentations and treatment needs in AIDS/human immunodeficiency virus (HIV)-infected subjects visiting antiretroviral therapy centers. Materials and Methods: The study included 126 subjects. Oral cavity was assessed and dentition, periodontal condition, and lesions and conditions affecting the oral mucosa were identified along with their treatment needs. The collected data were subjected to statistical evaluation and the results were formulated. Results: Candidiasis was seen in 25.39% (n = 32) of total subjects. Concerning the periodontal status of HIV-infected study population, it was seen that maximum attachment loss both in males and females was within the range of 0–3 mm. Regarding decayed, missing, and filled teeth scores, these were statistically significantly higher in males (P = 0.001). Conclusion: The present study concluded that the majority of subjects infected with HIV present one or more oral presentation and lesion, with candidiasis being the most common condition.

Keywords: Acquired immunodeficiency syndrome, antiretroviral therapy, candidiasis, dentition status, human immunodeficiency virus, treatment needs


How to cite this article:
Barbi W, Shalini K, Kumari A, Raaj V, Gupta H, Gauniyal P, Rangari P. Assessment of oral health and prevalence of oral conditions in human immunodeficiency virus-infected subjects visiting antiretroviral therapy centers. J Pharm Bioall Sci 2021;13, Suppl S2:1470-3

How to cite this URL:
Barbi W, Shalini K, Kumari A, Raaj V, Gupta H, Gauniyal P, Rangari P. Assessment of oral health and prevalence of oral conditions in human immunodeficiency virus-infected subjects visiting antiretroviral therapy centers. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Oct 7];13, Suppl S2:1470-3. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1470/330045




   Introduction Top


Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV) and is a deadly disease. AIDS itself does not lead to fatality. However, HIV leads to a broken and weaker immune system by attacking the immune system of the affected individual.[1] This weakened immune system makes the individual prone to various opportunistic infections which are life-threatening including various carcinomas and disorders affecting the neurological system. The HIV infection was first identified in homosexual males in 1981 by the Centers for Disease Control and Prevention in the USA.[2]

HIV can be transmitted from one individual to another via various routes including unprotected sex with affected individuals, sex with multiple partners, injectable drug abuses, blood transfusions, multiple needle use, and/or heterosexual route.[3] Approximately one lakh individuals died of HIV. A decrease in the trend of new affected AIDS subjects is seen with increasing in subjects seeking treatment as reported since 2014.[4]

The first AIDS case was reported in India by a sex worker from Chennai in 1986. As of 2017, approximately 21 lakh subjects had HIV in India with 0.22% adults of age 15 years to 50 years infected. India is emerging as a third country with the highest number of HIV cases after South Africa and Nigeria. The state with maximum HIV cases in India is Mizoram followed by Manipur and Nagaland.[5]

From April 2004, a program was launched in India under the National AIDS Control Program where free antiretroviral therapy (ART) was given to the subjects with AIDS/HIV. From 2004 to 2016, the number of ART centers in India increased from 8 to 528.[6] Although the ART centers were increased in number largely from 2004 to 2016, the program still needs to provide ART regimen in simple and standardized ways with negligible detrimental effects.[7]

Oral lesions also provide a valuable prognostic factor in HIV-infected subjects. Large data in the literature previously focused on the oral manifestation of AIDS and its importance. Such data are relatively scarce in the Asian population.[8] Hence, the present trial was done to assess the prevalence of oral presentations in AIDS/HIV-infected subjects visiting ART centers.


   Materials and Methods Top


The present cross-sectional trial was done to assess the prevalence of oral presentations in AIDS/HIV-infected subjects visiting ART centers. Furthermore, the present study was aimed to evaluate the treatment requirements and health status in AIDS/HIV subjects visiting ART center. The study included a total of 126 subjects including both males and females within the age group of 6 years to 58 years with a mean age of 27.3 years.

The subjects who gave consent for the study and were present at the days of study assessment were included in the trial. The ethical clearance for the study was given by the institutional ethical forum. Informed consent was taken verbally from all the subjects. The patients who were not in a physical or mental condition to provide consent, subjects in intensive care unit, subjects with severe psychological illness, and who were not willing to participate were excluded from the study.

After inclusion in the study, the oral cavity of all 126 subjects was assessed with disposable diagnostic instruments including a mouth mirror, tweezers, and community periodontal index probe. Furthermore, the straight probe was used to assess dental caries. For assessing and recording the dentition, periodontal condition, and lesions and conditions affecting the oral mucosa, modified Oral Health Assessment form of 1997 by the WHO was used in the present study.

The collected data were subjected to statistical evaluation and the results were formulated. The level of significance was kept at P ≤ 0.05.


   Results Top


Candidiasis was common infection that was seen in 31.81% (n = 14) of females, 32.92% (n = 27) of males, and 32.53% (n = 41) of total study subjects, followed by ANUG seen in 22.72% (n = 10) of females, 26.82% (n = 22) of males, and 25.39% (n = 32) of total subjects. The least common finding was malignancy/carcinomas seen in only 2 males and 1 female subject. Statistically significant difference among the genders was seen concerning only leukoplakia where no female had it and 6.09% (n = 5) of males had leukoplakia (p>0.0001) [Table 1].
Table 1: Oral lesions and conditions in HIV patients

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The difference in attachment loss scores was statistically significant in the male and female population for all the scores and ranges of attachment loss. It was seen that 34.09% (n = 15) females had attachment loss, whereas the value was 65.85% (n = 54) males had attachment loss which was statistically significant with a P = 0.001. [Table 2] also showed corruption perceptions index scores for study subjects, where it was seen that24 females had a score of 2 which was seen in 40 males (48.78%), and the difference was statistically significant between males and females with P = 0.001 [Table 2].
Table 2: Periodontal status in HIV patients

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Regarding decayed, missing, and filled teeth (DMFT) scores, decayed scores for males and females, respectively, were 3.38 ± 1263 and 2.76 ± 1.012 with statistically higher values in males (P = 0.001). M scores were 0.86 ± 0.676 and 0.52 ± 0.503, respectively, for males and females, which was also significantly higher in males (P = 0.001). Filled surfaces showed no statistical difference with P = 0.69; total DMFT was also statistically significantly higher in males (P = 0.001) as summarized in [Table 3].
Table 3: Decayed missing and filled teeth and dentition status in human immunodeficiency virus infected study subjects

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The treatment needs of HIV subjects were also assessed in the present study as described in [Table 4]. The results showed that maximum subjects, both males and females, required single-surface restorations as needed by 72.72% (n = 32) of females and 85.36% (n = 70) of males with significantly higher need in males (P = 0.001). A similar statistically significant difference was seen for pit and fissure sealant requirement, which was higher in males, 3.96% (n = 5), and in only 1 female (P = 0.01). Prosthesis, extractions, and pulpal treatments were also needed by HIV-infected subjects.
Table 4: Treatment needs in human immunodeficiency virus infected study subjects

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   Discussion Top


It was seen that approximately 70% of the study subjects having HIV and visiting ART centers had one or more oral manifestations. These findings were consistent with the findings of the previous studies by Rath and Raj.[9] in 2013 and Kumar et al.[10] in 2014 where the authors reported oromucosal lesions in 68.8% and 7% of their study subjects, respectively. In 4.76% of subjects (n = 6), the abscess was seen, which was also in agreement with the study of Kumar et al.[10] in 2014 where 3.97% of HIV subjects had an abscess.

It was seen that the most common lesion seen was candidiasis, which is a common infection that was seen in 31.81% (n = 14) of females, 32.92% (n = 27) of males, and 32.53% (n = 41) of total study subjects. These findings were similar to findings of Divakar et al.[11] in 2015 where 28.7% of subjects had candidiasis. However, results were contradictory to the study of Beena[12] in 2015 where only 11.62% of HIV subjects were seen with candidiasis. Statistically significant difference among the genders was seen concerning only leukoplakia where no female had it and 6.09% (n = 5) of males had leukoplakia with the P value of 0.001. These results were following the results of Agbelusi and Wright[13] in 2005 where they reported Kaposi's sarcoma in 2.3% of cases and by Ranganathan et al.[14] in 2007 who reported 2% leukoplakia in males.

Regarding DMFT scores, decayed scores for males and females, respectively, were 3.38 ± 1263 and 2.76 ± 1.012 with statistically higher values in males (P = 0.001). M scores were 0.86 ± 0.676 and 0.52 ± 0.503, respectively, for males and females, which was also significantly higher in males (P = 0.001). Filled surfaces showed no statistical difference with a P value of 0.69; total DMFT was also statistically significantly higher in males (P value = 0.001). These results coincided with the study of Eldidge and Gallagher[15] in 2000 and contraindicated the findings of Naidoo and Chikte[16] in 2004. More DMFT scores in AIDS-infected subjects show poorer oral health in infected subjects.


   Conclusion Top


Within its limitation, the present study concluded that the majority of subjects infected with HIV present one or more oral presentation and lesion, with candidiasis being the most common condition. Periodontal status and dentition were also seen to be compromised in subjects infected with HIV. These oral manifestations can be diagnostic and can help in early detection, screening, and management of AIDS. This can also help dentists and community health-care providers in assisting the AIDS/HIV detection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chaudhary P, Manral K, Gupta R, Bengani AK, Chauhan BI, Arora D. Oral health status and treatment needs among HIV/AIDS patients attending antiretroviral therapy center in Western India: A cross-sectional study. J Family Med Prim Care 2020;9:3722-8.  Back to cited text no. 1
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Benito N, Moreno A, Miro J, Torres A. Pulmonary infections in HIV-infected patients: An update in the 21st century. Eur Respir J 2012;39:730-45.  Back to cited text no. 2
    
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Dang AT, Cotton S, Sankaran-Walters S, Li CS, Lee CY, Dandekar S, et al. Evidence of an increased pathogenic footprint in the lingual microbiome of untreated HIV infected patients. BMC Microbiol 2012;12:153-10.  Back to cited text no. 3
    
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Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: A plan for the United States. JAMA 2019;321:844-5.  Back to cited text no. 4
    
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Ghate M, Tripathy S, Gangakhedkar R, Thakar M, Bhattacharya J, Choudhury I, et al. Use of first-line antiretroviral therapy from a free ART program clinic in Pune, India – A preliminary report. Indian J Med Res 2013;137:942-9.  Back to cited text no. 6
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Iacob SA, Iacob DG, Jugulete G. Improving the adherence to antiretroviral therapy, a difficult but essential task for a successful HIV treatment – Clinical points of view and practical considerations. Front Pharmacol 2017;8:831.  Back to cited text no. 7
    
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Lauritano D, Moreo G, Oberti L, Lucchese A, Di Stasio D, Conese M, et al. Oral Manifestations in HIV-positive children: A systematic review. Pathogens 2020;9:88.  Back to cited text no. 8
    
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Rath H, Raj SC. Assessment of oral health status and treatment needs of HIV/AIDS patients visiting government hospitals and rehabilitation centers in Bangalore city. Indian J Sex Transm Dis AIDS 2013;34:59-60.  Back to cited text no. 9
    
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Kumar S, Mishra P, Warhekar S, Airen B, Jain D, Godha S. Oral health status and oromucosal lesions in patients living with HIV/AIDS in India: A comparative study. AIDS Res Treat 2014;2014:1-4.  Back to cited text no. 10
    
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Divakar DD, Kheraif AL, Ramakrishnaiah R, Khan AA, Sandeepa NC, Alshahrani OA, et al. Oral manifestations in human immunodeficiency virus-infected pediatric patients receiving and not receiving antiretroviral therapy: A cross-sectional study. Paediatr Croat 2015;59:152-8.  Back to cited text no. 11
    
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Beena JP. Gingival status: An indicator of disease progression and its correlation with the immunologic profile in HIV-infected children on antiretroviral therapy. J AIDS HIV Res 2015;7:68-73.  Back to cited text no. 12
    
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Agbelusi GA, Wright AA. Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria. Oral Dis 2005;11:370-3.  Back to cited text no. 13
    
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Ranganathan K, Magesh KT, Kumarasamy N, Solomon S, Viswanathan R, Johnson NW. Greater severity and extent of periodontal breakdown in 136 south Indian human immunodeficiency virus seropositive patients than in normal controls: A comparative study using community periodontal index of treatment needs. Indian J Dent Res 2007;18:55-9.  Back to cited text no. 14
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Eldidge K, Gallagher JE. Dental caries prevalence and dental health behavior in HIV-infected children. Int J Paediatr Dent 2000;10:19-26.  Back to cited text no. 15
    
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Naidoo S, Chikte U. Oro-facial manifestations in pediatric HIV: A comparative study of institutionalized and hospital outpatients. Oral Dis 2004;10:13-8.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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