Provision of dental services in a dedicated clinic for HIV infected people in Greece.

OBJECTIVES: An observational study was carried out in order to describe the experience gained from the establishment of a dedicated dental clinic for HIV-infected people in Athens, Greece. METHODS: Data were collected retrospectively from the files of HIV-seropositive individuals attending the dedicated clinic for a period of seven years (1997-2003) and included the following variables: demographic characteristics, transmission route of HIV disease, oral lesions, general health concerns, dental visiting behavior before and after HIV-disclosure and dental procedures, carried out during the study period. RESULTS: The study patients comprised 426 HIV-seropositive individuals; 355 male (83%), 71 female (17%), mean age 40 years (range 17-76). The predominant mode of acquisition of HIV infection was sexual contact (88.5%), followed by intravenous drug abuse (3.8%), blood transfusion (2.5%) and vertical transmission (0.3%). Most of the patients attended the dedicated clinic because of direct/indirect denial of treatment by their dentist (29.1%), fear of attending their dentist (20.6%), financial constraints (17.5%), or because they were seeking specialized services (2.4%). Nearly half of the patients (46%), after they have been informed about their HIV-seropositivity, either did not attend their dentist, or did not disclose their HIV-status when they did attend. The type of 4688 dental procedures carried out during the study period, were the same as those performed in any general dental practice, without exhibiting increased risk of post-treatment complications. Finally, a relatively low overall incidence (41%) of oral lesions was observed, due to the effect of the highly active anti-retroviral therapy (HAART). CONCLUSIONS: Dedicated dental clinics can play a supplementary, but substantial role in the overall management of people whose HIV-status, or HIV-related clinical problems may prevent them from obtaining treatment from general dental practitioners within Greece.

Presence of human herpes virus-8 in saliva and non-lesional oral mucosa in HIV-infected and oncologic immunocompromised patients.

BACKGROUND/AIM: Human Herpes Virus-8 (HHV-8) is a recently identified virus etiologically associated with Kaposi's sarcoma. Studies regarding its presence in the oral cavity have given variable results. This study attempted to determine the oral presence of HHV-8 in an area where classic Kaposi's sarcoma is primarily found such as Greece. METHODS: Three groups of patients were studied: 10 immunocompromised with hematologic malignancies, 10 immunocompromised with HIV infection and 20 immunocompetent as controls. Whole unstimulated saliva and scrapes from the lingual and the buccal mucosa were collected and polymerase chain reaction was applied to amplify HHV-8 DNA. RESULTS: None of the patients in any group had oral lesions. In the control group, all samples tested negative (0/60). HHV-8 DNA was detected in 5/30 (17%) of all samples from HIV-positive patients (the mean value of their CD4+ T-lymphocytes being 385/mm3) and in 13/30 (43%) of all samples from oncologic patients (mean CD4+ T-lymphocytes 51/mm3). HHV-8 DNA was found in 10% of saliva samples and 40% of lingual and buccal scrapes both of HIV-infected and of oncologic patients. CONCLUSION: HHV-8 is present in the saliva and the non-lesional oral mucosa (not simultaneously) of patients with impaired immunity, with or without HIV co-infection. The oral epithelium seems to represent an independent location of viral residency and may be of viral replication; the clinical implications need further clarification.

Tissue distribution of Epstein-Barr virus genotypes in hosts coinfected by HIV.

BACKGROUND: In healthy people, oral and pharyngeal epithelium preferentially carries Epstein-Barr virus (EBV) belonging to a genotype that possesses three copies of a 29 base-pair repeat in the first intron of the BZLF-1 gene, while peripheral blood mostly carries a genotype that bears two copies. Whether EBV shows differential tropism in HIV-1-coinfected hosts, who are prone to develop oral hairy leukoplakia, has not been studied. METHODS: Tongue scrapings and CD45+-enriched peripheral blood cells of 20 HIV1-infected patients and 40 healthy controls were examined. EBV-specific DNA was amplified from segments in the first intron of the BZLF-1 gene, in exon C of the LMP-1 gene, and the type A/B-specifying domain of the EBNA-3C gene. Size polymorphisms of these amplicons were assessed by agarose gel electrophoresis, and DNA sequence differences among BZLF-1 gene amplicons by single-strand conformation polymorphism analysis. RESULTS: The predominant EBV genotype in peripheral blood as well as tongue carried two copies of the BZLF-1 repeat. In controls, although the BZLF-1 genotype with two copies was exclusively detected in the blood, the genotype with three copies predominated in the tongue. The findings could not be correlated with EBV genotyped according size polymorphisms in the EBNA-3C or LMP-1 genes. DNA sequences of a proportion or all of the clones derived from the BZLF-1 amplicons in the tongues of HIV-1-infected patients were identical to those in the blood. CONCLUSIONS: These findings are consistent with EBV haematogenous superinfection of the tongue of HIV-positive individuals. Such superinfection may precede or lead to the development of oral hairy leukoplakia.

Diversity of naturally occurring Epstein-Barr virus revealed by nucleotide sequence polymorphism in hypervariable domains in the BamHI K and N subgenomic regions.

The extent of nucleotide sequence microheterogeneity varies among subgenomic regions of Epstein-Barr virus (EBV). We examined, in EBV-carrying lymphoid cell lines, the extent of polymorphism in EBV DNA fragments amplified from the BamHI E, K, N and Z regions, and then investigated the diversity of the more hypervariable regions in tissues and body fluids. In cell lines, sequence dissimilarities in a genotype-specifying fragment of the EBNA-3C gene varied from < 1-4% within each genotype; dissimilarities in the first intron of the BZLF- 1 gene were < 2% within each genotype. By contrast, dissimilarities in a C-terminal unique domain of the EBNA-1 gene, and in a fragment that encompasses and is upstream of the LMP-1 start codon, varied between 2 and 7% and were not genotype-specific. The sequence diversity in BamHI K and N regions was then examined in tissues and body fluids by single-strand conformation polymorphism (SSCP) analysis and cycle sequencing. Extensive inter-host diversity was observed, whether the host was co-infected by human immunodeficiency virus (HIV) or not. In the oral cavity of HIV-infected patients, inter-compartmental EBV diversity could be demonstrated, even between sites that were anatomically proximate. Studies of BamHI K clones derived from EBV in oral lesions revealed infection by multiple variants. Identification of hypermutable loci within the EBV genome such as those located in the BamHI K and N regions should permit fine discrimination of individual EBV variants.

Oral hairy leukoplakia: clinicopathologic features, pathogenesis, diagnosis, and clinical significance.

Oral hairy leukoplakia (OHL) is a lesion frequently, although not exclusively, observed in patients infected by human immunodeficiency viruses (HIV). OHL is clinically characterized by bilateral, often elevated, white patches of the lateral borders and dorsum of the tongue. Histologically, there is profound acanthosis, sometimes with koilocytic changes, and a lack of a notable inflammatory infiltrate. The koilocytic changes are due to intense replication of Epstein-Barr virus (EBV), while epithelial hyperplasia and acanthosis are likely to result from the combined action of the EBV-encoded proteins, latent membrane protein-1, and antiapoptotic BHRF1. How OHL is initiated and whether it develops after EBV reactivation from latency or superinfection remain unresolved; nevertheless, definitive diagnosis requires the demonstration of EBV replicating vegetatively in histological or cytological specimens. In patients with HIV infection, the development of OHL may herald severe HIV disease and the rapid onset of AIDS, but despite its title, OHL is not regarded as premalignant and is unlikely to give rise to oral squamous cell carcinoma.

Computer assisted learning (CAL) of oral manifestations of HIV disease.

General dental practitioners (GDPs) in the UK may wish additional education on relevant aspects of human immunodeficiency virus (HIV) disease. The aim of the present study was to develop and assess a computer assisted learning package on the oral manifestations of HIV disease of relevance to GDPs. A package was developed using a commercially-available software development tool and assessed by a group of 75 GDPs interested in education and computers. Fifty-four (72%) of the GDPs completed a self-administered questionnaire of their opinions of the package. The majority reported the package to be easy to load and run, that it provided clear instructions and displays, and that it was a more effective educational tool than videotapes, audiotapes, professional journals and textbooks, and of similar benefit as post-graduate courses. The GDPs often commented favourably on the effectiveness of the clinical images and use of questions and answers, although some had criticisms of these and other aspects of the package. As a consequence of this investigation the package has been modified and distributed to GDPs in England and Wales.