Determinants of periodontitis according to the immunological and virological profiles of HIV-infected patients in Yaound\xe9, Cameroon

Joseph Fokam,Alexis Ndjolo,Alex Durand Nka,Buolikeze Kuoh Nji Geh,Desire Takou,Samuel Martin Sosso,Anne-Cecile Z.-K Bissek,Ezechiel Semengue Ngufack,David Mindja Eko

doi:10.1186/s12903-020-01353-7

Abstract

BackgroundHIV infection is associated to different oral manifestations (including periodontal diseases), which have decreased with the advent of antiretroviral therapy (ART). Yet, the occurrence of periodontitis is still consistent among patients with HIV living in sub Saharan-Africa, with limited evidence on the driven factors and mitigating measures in these settings. We aimed at evaluating the occurrence of periodontitis and its associated immunological and virological factors in patients with HIV living in Yaoundé, Cameroon.MethodsWe included 165 (44 ART-naïve and 121 ART-experienced) patients > 18 years old attending the Yaoundé Central Hospital and the Chantal BIYA International Reference Centre, from January-April 2018. The periodontal status was assessed by measuring the clinical attachment loss, periodontal pocket depth, plaques index and gingival bleeding index. CD4+/CD8+ cells and viremia were measured using the fluorescence-activated cell sorting method (FACS Calibur) and the Abbott m2000 RT HIV-1 RNA kit respectively. A standard-questionnaire concerning participants’ medical records and oral hygiene methods was filled. Data was analyzed and p < 0.05 considered statistically significant.ResultsThere was a significantly high prevalence of periodontitis in the ART-naïve (53.2%) compared to the ART-experienced group (37.3%), with a twofold increased risk of the ART-naïve population presenting with periodontitis than the ART-experienced population (OR 2.06, p = 0.03). More importantly, ART-naïve, patients with CD4 < 200 cells presented with higher risk of having periodontitis compared to those with higher CD4-values, with a threefold difference (OR 3.21). Worth noting, males presented with a higher risk of having clinical attachment loss (OR 6.07). There was no significant association between the occurrence of periodontitis and the CD8 (p = 0.45) or viremia (p = 0.10).ConclusionIn the Cameroonian context, a considerable number of adults infected with HIV suffer from periodontitis regardless of their treatment profile. Nonetheless, ART-naïve patients have a higher risk, indicating the protective role of ART. Interestingly, severely immune-compromised patients and men are vulnerable to periodontitis, thereby highlighting the need for clinicians to refer patients for regular periodontal screening especially male patients and those with low CD4. Such measures could greatly improve the quality of life of the population living with HIV in Cameroon.

Highlights

Human immunodeficiency Virus (HIV) infection is associated to different oral manifestations, which have decreased with the advent of antiretroviral therapy (ART)
HIV is a retrovirus, whose infection is characterized by a combination of clinical manifestations which are caused by the infection directly and killing of Cluster differentiation cells (CD4)+ lymphocytes, decreasing the natural defense mechanism leading and severe immunodeficiency
The immunological parameter usually used for this evaluation is the CD4/CD8 T-lymphocyte counts in peripheral blood and plasma viral load, which appear to play an important role in the progression of periodontal disease and the course of HIV-infection [9]

Summary

Introduction

HIV infection is associated to different oral manifestations (including periodontal diseases), which have decreased with the advent of antiretroviral therapy (ART). The occurrence of periodontitis is still consistent among patients with HIV living in sub Saharan-Africa, with limited evidence on the driven factors and mitigating measures in these settings. We aimed at evaluating the occurrence of periodontitis and its associated immunological and virologi‐ cal factors in patients with HIV living in Yaoundé, Cameroon. To reduce the risk of opportunistic infections, including oral manifestations, international medical associations developed guidelines for starting antiretroviral treatment despite the CD4 cell counts in these patients known as the test and treat approach implemented in Cameroon since 2016 [7]. The immunological parameter usually used for this evaluation is the CD4/CD8 T-lymphocyte counts in peripheral blood and plasma viral load, which appear to play an important role in the progression of periodontal disease and the course of HIV-infection [9]

Methods

Results

Conclusion