Abstract
BackgroundThe immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The aim of the study was to establish whether HIV stage (as depicted by CD4+ T lymphocyte counts) could independently be associated with periodontal status (as revealed by the measurement of clinical indices).MethodsOne hundred and twenty HIV-infected patients attending an infectious diseases clinic in the Western Cape, South Africa were included in the study. The periodontal clinical indices such as plaque index, gingival index, pocket probing depth and clinical attachment levels were measured on the mesial aspect of the six Ramfjord teeth. The CD4 + T cell counts were taken from the patients’ medical records and patients’ HIV stage determined and grouped according to their CD4+ T cell counts into A (<200 cells /mm3), B (200–500 cells /mm3) and C (>500 cells /mm3).ResultsThe mean age of 120 HIV-positive patients was 33.25 years and the mean CD4 + T cell count was 293.43 cells/mm3. The probing depth and clinical attachment loss were found to be significantly associated with the total CD4 + T cell counts but not with HIV stage. Significant correlations were found between age and all clinical indices except for clinical attachment loss. No correlation was found between age and HIV stage of the patients. The use of antiretroviral therapy was significantly associated with probing depth and clinical attachment loss, but not with plaque nor gingival index. Significant associations were observed between smoking and all of the clinical indices except for the gingival index. A significant association was observed between the use of interdental aids and all the clinical indices except for probing depth, while brushing was significantly associated with plaque index only. CD4 + T cell counts were significantly associated with brushing frequency (p = 0.0190) and the use of interdental aids (p = 0.0170).ConclusionThe findings of this study conclude that HIV stage, ART and age are not independent risk factors for changes in the periodontal status of HIV-positive subjects but rather that smoking and oral hygiene habits determine their susceptibility to disease.
Highlights
The immunosuppresion in human immunodeficiency virus (HIV) patients makes them highly susceptible to microbial infections
Considered as one of the earliest clinical features of HIV infection [3], many studies have related the degree of immunosuppression and HIV viral load with the progression and exacerbation of chronic inflammatory periodontal disease (CIPD) [4,5], with prevalence and severity ranging from 1-66% for gingivitis and 0-91% for periodontitis [6,7]
With the periodontium serving as a reservoir for microorganisms, other factors such as inadequate oral hygiene, smoking, age, and HIV stage are recognized as risk factors which predispose an individual to periodontal disease [8,9,10,11,12,13]
Summary
The immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The pathogenesis of HIV infection is considered to be related to the depletion or reduction of CD4 + T helper cells, causing profound immunosuppression which may predispose the individual to aggressive gingivitis or periodontitis unresponsive to conventional therapy [2]. Considered as one of the earliest clinical features of HIV infection [3], many studies have related the degree of immunosuppression and HIV viral load with the progression and exacerbation of chronic inflammatory periodontal disease (CIPD) [4,5], with prevalence and severity ranging from 1-66% for gingivitis and 0-91% for periodontitis [6,7]. With the periodontium serving as a reservoir for microorganisms, other factors such as inadequate oral hygiene, smoking, age, and HIV stage (immunodeficiency) are recognized as risk factors which predispose an individual to periodontal disease [8,9,10,11,12,13]. The age concept has been challenged and it is considered that with proper oral hygiene maintenance, periodontal disease can be prevented [14]
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