HIV and other retroviral diseases (related oral infections) in Afro-Asian countries - PowerPoint Presentation

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HIV and other retroviral diseases (related oral infections) in Afro-Asian countries

Dr. Cathy Nisha JohnUniversity of the Western Cape

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35 million HIV patients worldwide

5.6 million HIV people living in South Africa (UNAIDS 2013)

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HTLV1(Human T cell lymphotropic virus type1)

15 to 20 million HTLV-1 positive patients, are infected worldwide [2000]Africa and East and Central Asia are probably the largest endemic area for HTLV-1 (2012)

An association between HTLV-1 infection and reduced salivary flow resulting in the progression of dental diseases were reported (Aline,2014)

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HIV and oral diseases

The more HIV virus being produced by the body, the more rapidly the oral disease progresses (

Journal of Periodontal 2015)seen in 30–80% of the affected patient population

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Oral diseases

Infections: fungal, viral, bacterialNeoplasms: Kaposi's sarcoma, non-Hodgkin's lymphomaImmune mediated: aphthous

stomatitis, necrotizing stomatitisOthers: parotid diseases,

xerostomia

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Fungal Infections

Candidiasis

Erythematous candidiasis-CD4count less than 300cells/mm³

red, flat, subtle lesion either on the hard/soft palates or on the dorsal surface of the tonguesevere burning sensation in the mouth while eating salty and spicy food

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Pseudomembranous

candidiasis - creamy white curd-like plaques on the buccal mucosa, tongue can be wiped away, leaving a red or bleeding surface

Hyperplastic or chronic candidiasis

– white plaques over the mucosal surfaceNonremovable and hence cannot be scraped off.

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Angular cheilitis -

erythema and/or fissuring and cracks of the corners of the mouth. occurs with or without the presence of erythematous candidiasis or pseudomembranous

candidiasis.

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Viral Infections

Oral hairy leukoplakia-

Epstein–Barr virus (EBV) CD4 lymphocyte count less than 200 cells/mm³Heterosexual transmission (Nittayananta

, 2010) bilateral and asymptomatic appear as vertical white striations, or as flat, or raised, shaggy plaques with hair-like keratin projections on tongue

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Herpes simplex virus infections (HSV)

clusters of painful small vesicles that rupture and ulcerate and usually heal within 7 to 10 daysRecurrent HSV appears on oral mucosa (palate, dorsum of tongue, and gingiva)

recurrent herpes simplex infections may be more common in patients with symptomatic HIV disease (Greenspan,1998)

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Cytomegalovirus

infections(CMV) CytomegalovirusCD4 count below 50Painful ulcerations of

gingiva and tongue.Enlargement of parotid and submandibular gland, dry mouth

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Human papilloma

virus infection (HPV)HPV virusSeen as either pedunculated or sessile oral warts with a papillomatous appearance

palate, buccal mucosa and labial commissure

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The immunosuppression

in HIV-infected individuals triggers the re-activation of human herpes virus (HHV) infection leading to severe HIV-associated periodontal disease. (Slots and Contreras, 2000; Cappuyns, 2005)

Cytomegalovirus (HHV 5), Epstein-Barr virus type-I (HHV4) (Contreras et al, 1999) detected with higher frequency in

subgingival plaque samples from HIV-positive individuals with periodontal disease than from healthy or HIV-negative subjects (

Mardrossian

et al

, 2000).

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Bacterial infections CHRONIC INFLAMMATORY PERIODONTAL DISEASE

Chronic gingivitis- gingival inflammation involving either Gram-negative or Gram-positive bacteria at or under the gingival crevice

Chronic periodontitis- destruction of the periodontium

resulting in tooth mobility and consists predominantly of Gram-negative bacteriaThe primary aetiology- dental plaque consists of at least 800 bacterial species (Aas

et al,

2005, 2008)

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Acute necrotizing ulcerative gingivitis (ANUG)

CD4+T cell counts less than 200 cells/mm³.Painful punched out crater like depressions on the crest of the interdental papillae.

Rapid onset but resolves quickly

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Acute necrotizing ulcerative periodontitis(ANUP)

painful ulceration and necrosis of interdental papillae and gingival marginsPeriodontal destruction with attachment loss and alveolar bone loss

Tooth mobility and tooth loss

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Acute necrotizing stomatitis (ANS)

NUG and NUP, if untreated, can progress to ANS which is manifested by the extension of necrosis past the periodontium into the mucosa and the osseous tissue (Robinson

et al, 1998)A study conducted in South Africa, demonstrated a significant correlation between necrotizing diseases and severe

immnunosuppression, with a positive predictive value of 69.6% (Shangase et al, 2004)

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Kaposi's sarcomaHuman herpes virus (HHV8) appear as a red-purple

macule or a nodule or masshomosexual and bisexual males

Non-Hodgkin's lymphomaCD4 counts less than 100cells/mm3

rapidly enlarging mass or ulcer on the palate or gingivaPoor prognosis

Neoplasms

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Sjogren’s

sydrome

parotid gland enlargementReduced salivary flowdry, erythematous oral mucosa

Burning mouthrecurrent cariesHigher incidence of dry mouth, decreased salivary flow, periodontal disease, and gingival attachment loss were reported in 115 HTLV-1 patients (

Lins

, 2012)

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Research

Association between CD+T cell counts and chronicinflammatory periodontal disease in 120 HIVpositive patients

METHODS

CD4 counts were taken from the medical recordsPeriodontal disease measurements such as plaque index, Probing depth and Clinical attachment loss were measured on the

mesial

aspect of the teeth

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CD4+T cell counts relative to Plaque index

p value= 0.8696 Mean(SD)= 2.55(0.54)

No statistical significance

between PI and CD4+T cell counts

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CD4+T cell counts relative to Probing depth

p value=

0.0434

Mean(SD)=4.77(1.04)

Statistical significance exists between

PD and

CD4+T cell counts

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CD4+T cell counts relative to Clinical attachment loss

p value= 0.0268

Mean(SD)=5.29(1.1)

Statistical significance

exists between

CAL and

CD4+T cell counts

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To determine an association between CD4+Tcell counts and oral hygiene in HIV-positive patients 

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CD4+T cell counts relative to Brushing frequency

p value=0.0190

CD4+

Tcellcount

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CD4+T cell counts relative to the use of

interdental aids p value = 0.0170

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CONCLUSION we could determine that the level of immunosuppression in HIV patients is associated with poor oral hygiene resulting in an accumulation of oral microorganisms, eventually leading to chronic periodontal disease

.

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Low CD4 counts can be considered a risk factor for the development of oral lesions especially oral

candidiasis (Ravi JR,2015)

No association between periodontal disease and CD4 counts (Vastardis,2003)

Consequently, the microbial associations of HIV associated periodontal diseases are not thoroughly understood

(

Aas

et al

, 2007)

Lack of oral hygiene and CD4 + T cell counts <400 cells/mm

3

 may reduce the ability of the host to control infection by

periodontopathogens

, resulting in CIPD (Lewis,2003)

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SUMMARY

Oral health problems are common among people infected with retroviral diseasesThe higher the severity of immunosupression, the rapid is the progression of oral lesionsPatients must be encouraged to receive dental treatments at least every six monthsEarly identification of the oral conditions, prevention, diagnosis and treatments must be emphasized

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