Periodontal disease in HIV/AIDS.

Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.

Antifungal activity of the plant Dodonaea viscosa var. angustifolia on Candida albicans from HIV-infected patients.

THE AIM OF THIS STUDY: was to determine the minimum inhibitory concentration (MIC) and the time taken by Dodonaea viscosa var. angustifolia (PLE) a South African medicinal plant, chlorhexidine gluconate (CHX) and triclosan (TRN) to kill Candida albicans. 41 strains of Candida albicans were investigated, 20 from HIV-positive patients, 20 from HIV-negative subjects and Candida albicans ATCC 90028. The MICs of an acetone extract of PLE, CHX and TRN were measured using a microtitre double dilution technique, and the time taken to kill 99.5% of the strains was determined. The MICs of PLE, CHX and TRN were 6.25-25, 0.008-0.16 and 0.0022-0.009 mg/ml, respectively. PLE killed all the test strains within 30s and CHX 40% of the isolates from HIV-positive patients and 20% of strains from HIV-negative subjects in 1 min. During the same time TRN killed 55% and 35% of isolates from HIV-positive and HIV-negative patients. Dodonaea viscosa var. angustifolia has antifungal properties and is more effective than commercially available mouthrinses.

Effect of antifungal treatment on the prevalence of yeasts in HIV-infected subjects.

Oral candidiasis, the most common opportunistic infection in patients with HIV infection, is usually associated with Candida albicans. Several factors may influence the carriage of Candida, including immunocompromised conditions and HIV infection, colonization by yeasts from different geographical areas and antimycotic treatment. This study investigated the Candida carrier rate, level and types of yeast in HIV-positive and -negative subjects, and the effect of previous exposure to antifungal drugs on the level of yeasts in HIV-positive patients in Gauteng, South Africa. Unstimulated saliva was collected from 332 HIV-positive patients and 100 HIV-negative subjects and cultured for yeasts. The number and species of yeast were determined. HIV-positive patients who carried yeasts were divided into two groups depending upon their previous antifungal drug exposure, and the level of Candida carriage in each group was compared. The Candida carrier rate in the HIV-positive patients (81.3%) was slightly higher than previously reported and significantly higher (P<0.001) than in the HIV-negative group (63%). The carrier rate in the HIV-negative group was also higher than in earlier studies. Fourteen per cent of the HIV-positive patients carried more than 10,000 c.f.u. ml-1 whereas none of the HIV-negative subjects carried this large a number of yeasts (P<0.001). Seventy per cent of the yeasts were identified as C. albicans and approximately 30% as non-albicans species. In conclusion, the Candida carrier rate is higher in the South African population than elsewhere. HIV-positive patients carry more and a greater variety of yeasts than HIV-negative subjects. Exposure to antifungal drugs has no effect on the level of yeast carriage in HIV-positive patients.

Antifungal effect of mouth rinses on oral Candida counts and salivary flow in treatment-naïve HIV-infected patients.

Oral candidiasis is a major problem in developing countries where antiretroviral therapy is available to a small percentage of the infected population. HIV patients are prone to xerostomia and predisposed to Candida infection. Preventing oral candidiasis is better than the frequent use of antifungals that may lead to the development of drug resistance. This study investigated the ability of commercial mouth rinses and sodium bicarbonate to reduce salivary Candida and to improve the saliva flow of HIV-positive patients. One hundred fifty HIV patients without oral candidiasis were examined for oral lesions initially and after 2, 4, and 12 weeks. Unstimulated saliva was collected; the volume was measured and cultured for yeasts. Subjects were provided with mouth rinses containing either benzydamine hydrochloride, benzydamine hydrochloride with chlorhexidine gluconate, triclosan with sodium fluoride, 5% sodium bicarbonate, or placebo and asked to rinse twice daily for 12 weeks. The effect of the mouth rinses and placebo on Candida counts and saliva flow was analyzed using analysis of variance (ANOVA). A total of 108 patients completed the trial, 35 missed appointments, 4 died, 2 developed oral candidiasis, and 1 herpetic lesion. Triclosan/fluoride decreased the Candida count more than the placebo (p = 0.005) while chlorhexidine/benzydamine hydrochloride (p = 0.001) and triclosan/fluoride mouthrinses (p = 0.002) increased the salivary flow during the initial 4 weeks. The most effective mouth rinse triclosan/fluoride decreased oral Candida counts and increased saliva flow. Studies are needed to determine the efficacy of these mouth rinses for the long-term prevention of clinical oral candidiasis in adult HIV-positive patients.

Oral lesions in infection with human immunodeficiency virus.

This paper discusses the importance of oral lesions as indicators of infection with human immunodeficiency virus (HIV) and as predictors of progression of HIV disease to acquired immunodeficiency syndrome (AIDS). Oral manifestations are among the earliest and most important indicators of infection with HIV. Seven cardinal lesions, oral candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and non-Hodgkin lymphoma, which are strongly associated with HIV infection, have been identified and internationally calibrated, and are seen in both developed and developing countries. They may provide a strong indication of HIV infection and be present in the majority of HIV-infected people. Antiretroviral therapy may affect the prevalence of HIV-related lesions. The presence of oral lesions can have a significant impact on health-related quality of life. Oral health is strongly associated with physical and mental health and there are significant increases in oral health needs in people with HIV infection, especially in children, and in adults particularly in relation to periodontal diseases. International collaboration is needed to ensure that oral aspects of HIV disease are taken into account in medical programmes and to integrate oral health care with the general care of the patient. It is important that all health care workers receive education and training on the relevance of oral health needs and the use of oral lesions as surrogate markers in HIV infection.