The influence of antiretroviral therapy on HIV-related oral manifestations.

PURPOSE: This review aims to provide primary medical and dental healthcare professionals with the current state of information on the oral manifestations of HIV infection in the era of antiretroviral therapy (ART) advancements. RESULTS: Infection with the human immunodeficiency virus (HIV) is associated with an increased risk of infectious, neoplastic, and immune-mediated oral complications that are regarded as a major constituent of this global epidemic. HIV-related oral manifestations have been subject to changes in their prevalence with the employment of ART, particularly in this period of enhanced patient accessibility to ART. Available antiretroviral medications (ARVs), the clinical presentation of common HIV-related oral manifestations, and patients and healthcare providers' perceptions are also discussed. CONCLUSIONS: Screening, diagnosing, and treating patients with HIV/Acquired immunodeficiency syndrome (AIDS) has improved drastically since the isolation and characterization of HIV. Oral manifestations have been acknowledged to correlate with treatment responses and disease progression. Healthcare providers should be familiar with HIV-related oral manifestations and comfortable in managing and referring patients with HIV/AIDS, they are also key stakeholders in facilitating the elimination of the stigma associated with the infection.

Including oral health training in a health system strengthening program in Rwanda.

OBJECTIVE: Rwanda's Ministry of Health, with the Clinton Health Access Initiative, implemented the Human Resources for Health (HRH) Program. The purpose of the program is to train and retain high-quality health care professionals to improve and sustain health in Rwanda. DESIGN: In May 2011, an oral health team from Rwanda and the United States proposed that oral health be included in the HRH Program, due to its important links to health, in a recommendation to the Rwandan Ministry of Health. The proposal outlined a diagonal approach to curriculum design that supports the principles of global health through interconnected training for both treatment and collaborative prevention, rather than discipline-based fragmented training focused on isolated risk factors. It combined 'vertical' direct patient care training with 'horizontal' interdisciplinary training to address common underlying risk factors and associations for disease through primary care, program retention, and sustainability. RESULTS: The proposal was accepted by the Ministry of Health and was approved for funding by the US Government and The Global Fund. Rwanda's first Bachelor of Dental Surgery program, which is in the planning phase, is being developed. CONCLUSIONS: Competencies, the training curriculum, insurance and payment schemes, licensure, and other challenges are currently being addressed. With the Ministry of Health supporting the dental HRH efforts and fully appreciating the importance of oral health, all are hopeful that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-retained dental profession, and vastly improved oral health and overall health for the people of Rwanda in the decades to come.

Salivary histatin-5 and oral fungal colonisation in HIV+ individuals.

The oral cavity is a primary target for opportunistic infections, particularly oral candidiasis caused by the opportunistic pathogen Candida albicans. HIV+ individuals constitute a population highly susceptible to oral candidiasis possibly due to a change in the environment of the oral cavity as the result of salivary gland dysfunction. Histatins are a family of salivary antimicrobial peptides which under normal circumstances have a protective function on the oral mucosa. This study aimed to compare salivary histatin concentrations and oral fungal colonisation in an HIV+ and HIV- control populations. Oral samples for fungal cultures and parotid saliva were collected from all subjects. Fungal identification was determined using standard mycological procedures. In order to determine salivary histatin levels a semi-quantitative ELISA was designed using a specific polyclonal antibody and extensive statistical analysis was performed. Forty-seven percent of HIV+ and 17% of control subjects had positive fungal cultures. Mean histatin levels were 7.32 microg ml(-1) for the HIV+ group and 9.17 microg ml(-1) for control group (P = 0.003). The data from this study demonstrate that the level of fungal colonisation is significantly higher in HIV+ individuals whereas histatin-5 concentrations are significantly lower, likely contributing to the enhanced predisposition of this population to oral candidiasis.

Prevalence of oral manifestations of HIV infection in Rio De Janeiro, Brazil from 1988 to 2004.

After the introduction of highly active antiretroviral therapy (HAART), several studies have shown a decrease in the prevalence of HIV-associated oral lesions. The goal of this study is to evaluate the prevalence of oral manifestations of HIV in Brazil. A retrospective epidemiologic analysis was performed of medical records of HIV-positive patients who attended Clementino Fraga Filho University Hospital and the Stomatology Clinic of Federal University of Rio de Janeiro from 1988 to 2004. Gender, age, mode of HIV transmission, level of education, history of opportunistic infections, smoking, CD4 counts, viral load, antiretroviral therapy, and presence and site of oral lesions were assessed. One thousand twelve medical records were reviewed, resulting in 1230 entries in the study's database: 920 men and 310 women. There was a positive correlation between the prevalence of women, patients older than 40 years of age, and patients with 11 years or less of education. HAART was associated with a lower prevalence of oral manifestations. The prevalence of oral manifestations decreased throughout the years, while an increase occurred in the prevalence of oral warts and HIV-associated salivary gland disease (SGD). This study implies a social trend of AIDS in Brazil with an increase in the number of females, people 40 years of age and older, and with lower educational background. In Brazil, it can also be observed a reduction in the prevalence of oral manifestations reported worldwide and an increase in the prevalence of oral warts and SGD. To our knowledge, no study of this time frame has been done in a Brazilian population.

Oral manifestations in the era of HAART.

AIDS has reached epidemic proportions in the United States, disproportionately affecting African-Americans and other minorities. As highly active antiretroviral therapy (HAART) have improved the length and quality of life for HIV-Infected people, oral health care has made similar strides. It is important that physicians and dentists recognize the earliest signs and symptoms of HIV infection in order that a timely diagnosis and patient referral can be made for early counseling testing, and treatment. At the same time, dentists have seen themselves at considerable risk from HIV Infection. Some dentists believe that they may also be more at risk from stigma then other providers if they treat HIV patients.