Oral Health-Related Quality of Life Among People Living with HIV/AIDS

Abstract

Since it was first recognized in early 1980s, the Acquired Immunodeficiency Syndrome (AIDS) has been one of the most destructive diseases recorded in the world history. The devastating impact of HIV/AIDS on individual patient, family, community and the nation is vast. The disease not only robs a country of its monetary resources in covering for the costs of HIV prevention and treatment, but also of the nation’s human resources when young productive lives are affected. The latest statistics suggested that the overall growth of the disease has stabilised with declining number of new HIV cases since the last decade. However, the number of people living with HIV/AIDS (PLWHA) remained high and appeared to be still on the rise (UNAIDS, 2010). With increasing availability and use of highly active antiretroviral therapy (HAART) in 1996, fewer deaths due to AIDS-related diseases have been observed. Worldwide, about 1.8 million HIV-related deaths were reported in 2009 as compared to the peak 2.1 million in 2004. In Southern Alberta, Canada, analysis of AIDS death records between pre-HAART (1984-1996) and HAART (1997-2003) periods revealed reduction in crude mortality rate from 117 deaths per 1000 patient-years pre-HAART to 24 in the HAART period (Krentz et al., 2005). Across Europe, the HIV-related death rates reduced substantially between September, 1995, and March, 1998, in a large cohort of 4270 HIV-infected patients to less than a fifth of their previous level (Mocroft et al., 1998). A study in Taiwan compared the mortality rate of 10,162 HIV-infected patients whose diagnosis was made in three different periods: the preHAART period, from 1 January 1984 to 31 March 1997; the early HAART period, from 1 April 1997 to 31 December 2001; and the late HAART period, from 1 January 2002 to 31 December 2005 (Yang et al., 2008). Results showed that the mortality rate of HIV-infected patients declined significantly from 10.2 deaths per 100 person-years in the pre-HAART period to 6.5 deaths and 3.7 deaths per 100 person-years in the early and late HAART periods, respectively. This increase in survival rates contributes to the increasing number of PLWHA as AIDS is no longer a lethal disease but has been transformed into a chronic condition. Oral lesions are common in PLWHA. Some oral manifestations have been documented as early markers of HIV infection and as predictors of disease progression. Among the most common oral manifestations of HIV include oral candidiasis, oral hairy leukoplakia and necrotizing ulcerative periodontitis (Coogan et al., 2005; Ranganathan & Hemalatha, 2006).