Osteoporosis and periodontal diseases with HIV infection (review)

Abstract

Relevance. The life expectancy of people with HIV has increased thanks to the use of specific antiretroviral therapy (ART). Currently, one of the urgent medical problems for this cohort is osteoporosis. Immune reconstitution during ART leads to a sustained inflammatory reaction in the body, the release of cytokines, and activation of osteoclasts. Osteoporosis often causes complications in periodontology and implantology. The significant need of HIV-infected people for these types of dental care and the prevalence of periodontitis, including generalized forms, also determine the importance of this issue. Purpose. To identify the common links in the pathogenesis of systemic (osteoporosis – hereinafter referred to as OP) and local (jaw bones in periodontitis) osteoresorption, the main methods for the diagnosis, treatment and prevention of OP associated with HIV infection, its effect on the results of implantological treatment of adentia in this population. Materials and methods . Analysis of publications in scientific periodicals on OP + Periodontal Pathology + HIV/AIDS over the past decade (PubMed, Medline, Elibrary). Results. The etiology of bone structure disorders is multifactorial: chronic inflammation, direct impact of HIV on osteocytes, effect of ART (viral protease inhibitors) on bone metabolism and remodeling. The planning of specific therapeutic interventions should be individualized and aimed at the key links in the pathogenesis of osteoresorption (osteoprotectors, antiinflammatory agents, bisphosphonates, calcium supplements, vitamin D). Conclusion. The effectiveness of the bisphosphonate therapy of OP in this cohort and DEXA screening to control the risk of osteoresorption suggest a very likely clinically justified implantation method for the treatment of tooth loss in HIV infection. Topical issues of OP and periodontal pathology in connection with the aging of HIV patients should be considered as related. For them, the planning of specific diagnostic (DEXA, biochemical screening) and therapeutic (remineralizing agents, osteoprotectors, etc.) strategies involving narrowly specialized doctors (endocrinologists, gastroenterologists, etc.) becomes a decisive.