Oral and Systemic Comorbidities and its Relation to Cluster of Differentiation 4 Counts in Human Immunodeficiency Virus Patients on Highly Active Antiretroviral Therapy: An Observational Study
Ceena E Denny, John Ramapuram, Thattil S Bastian, Almas Binnal, Nanditha Sujir
CD4 count, Highly active antiretroviral therapy, Human immunodeficiency virus, Systemic comorbidity
Citation Information :
Denny CE, Ramapuram J, Bastian TS, Binnal A, Sujir N. Oral and Systemic Comorbidities and its Relation to Cluster of Differentiation 4 Counts in Human Immunodeficiency Virus Patients on Highly Active Antiretroviral Therapy: An Observational Study. World J Dent 2019; 10 (4):275-279.
Aims: Oral and systemic comorbidities are common in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and are considered to be important predictors of the disease. Cluster of differentiation 4 (CD4) count serves as an important marker for the progression of HIV to AIDS. Our objective was to correlate the oral and systemic comorbidities associated with HIV infection with CD4 count in patients on highly active antiretroviral therapy (HAART).
Materials and methods: This was an observational study among 110 HIV-diagnosed patients. The oral and systemic comorbidities were noted and compared to their CD4 counts. A Chi-square analysis was carried out to see the association of oral manifestations.
Results: Among the study subjects, 50 (45.5%) participants had a CD4 count of >500 cells/μL, 46 (41.8%) patients had a CD4 count of 200–499 cells/μL, whereas 14 (12.7%) had <200 cells/μL. The major oral manifestations observed were dental caries (n = 30, 60%), periodontitis (n = 25, 50%), and lipoatrophy (n = 25, 50%) in patients with CD4 >500 cells/μL; dental caries (n = 28, 60.90%), intraoral pigmentation (n = 23, 50%), and periodontitis (n = 20, 43.50%) in patients with a CD4 count between 200 and 499; and dental caries (n = 9, 64.30%), periodontitis (n = 7, 50%), and candidiasis 6 (42.90%) among subjects with CD4 counts <200. The most common systemic comorbidity observed was tuberculosis (p < 0.001) and pneumonia (p < 0.003).
Conclusion: Early intervention strategies in diagnosis and management for HIV-infected individuals have shown promising results. With the advent of HAART, the quality of life has significantly improved.
Clinical significance: The prevalence of oral and systemic comorbidity among HIV-infected patients have declined since the advent of HAART. Oral and general physicians should be able to identify and treat the patients at the earliest, which in turn could reduce the morbidity and mortality rates among those infected with HIV.
UNAIDS. 2018 Global AIDS Update: Miles to go—closing gaps, breaking barriers, righting injustices; July 2018.
National AIDS Control Organization & ICMR-National Institute of Medical Statistics (2018). HIV Estimations 2017: Technical Report. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India.
Dalgleish AG, Beverly PCL, et al. The CD4 (T4) antigen is an essential component of the receptor for the AIDS retrovirus. Nature 1984;312:763–767. DOI: 10.1038/312763a0.
Brenchley JM, Schacker TW, et al. CD4+ T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med 2004;200:749–759. DOI: 10.1084/jem. 20040874.
Berberi A, Aoun G. Oral lesions associated with human immunodeficiency virus in 75 adult patients: a clinical study. J Korean Assoc Oral Maxillofac Surg 2017;43:388–394. DOI: 10.5125/jkaoms.2017.43.6.388.
Davoodi P, Hamian M, et al. Oral Manifestations Related to CD4 Lymphocyte Count in HIV-Positive Patients. J Dent Res Dent Clin Dent Prospect 2010;4(4):115–119. DOI: 10.5681/joddd. 2010.029.
Menezes TO, Rodrigues MC, et al. Oral and systemic manifestations in HIV-1 patients. Rev Soc Bras Med Trop 2015;48(1):83–86. DOI: 10.1590/0037-8682-0179-2014.
National Guidelines on Prevention, Management and Control of Reproductive Tract Infections including Sexually Transmitted Infections, August 2007.
Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992 Dec 18; 41(RR-17):1–19. Accessed December 1, 2013.
Hoffman J, Griensven JV, et al. Role of the CD4 count in HIV management. HIV Ther 2010;4:27–39. DOI: 10.2217/hiv.09.58.
Hodgson TA, Greenspan D, et al. Oral lesions of HIV diseases and HAART in industrialized countries. Adv Dent Res 2006;19:57–62. DOI: 10.1177/154407370601900112.
de Faria PR, Vargas PA, et al. Tongue disease in advanced AIDS. Oral Dis 2005;11:72–80. DOI: 10.1111/j.1601-0825.2004.01070.x.
Gonçalves SFM, Carvalho CIM. Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count. An Bras Dermatol 2013 Aug;88(4):570–577. DOI: 10.1590/abd1806-4841.2013895.
Price J, Hoy J, et al. Changes in the prevalence of lipodystrophy, metabolic syndrome and cardiovascular disease risk in HIV-infected men. Sex Health 2015 Jun;12(3):240–248. DOI: 10.1071/SH14084.
Iwuala SO, Lesi OA, et al. Prevalence of and Risk Factors for Lipoatrophy in Patients with HIV Infection in Nigeria. AIDS Res Treat 2015;2015:402638. DOI: 10.1155/2015/402638.
Soares FMG, Costa IMC. Facial lipoatrophy and AIDS. Barros E. HIV Infection - Impact, Awareness and Social Implications of living with HIV/AIDS. InTech; 2011. pp. 61–80.
Baril JG, Junod P, et al. HIV-associated lipodystrophy syndrome: A review of clinical aspects. Can J Infect Dis Med Microbiol 2005;16: 233–243.
Aškinytė D, Matulionytė R, et al. Oral manifestations of HIV disease: A review. Stomatologija 2015;17(1):21–28.
Nittayananta W, Chanowanna N, et al. Risk factors associated with oral lesions in HIV infected heterosexual people and intravenous drug users in Thailand. J Oral Pathol Med 2001;30(4):224–230. DOI: 10.1034/j.1600-0714.2001.300406.x.
Gaurav S, Keerthilatha PM, et al. Prevalence of Oral Manifestations and Their Association with CD4/CD8 Ratio and HIV Viral Load in South India. Int J Dent 2011;2011:964278. DOI: 10.1155/2011/964278.
Epstein JB. Oral malignancies associated with HIV. J Can Dent Assoc 2007;73(10):953–956.
Chidzonga MM, Rusakaniko S. Ranula: another HIV/AIDS associated oral lesion in Zimbabwe. Oral Diseases 2004;10:229–232. DOI: 10.1111/j.1601-0825.2004.01013.x.
Syebele K, Munzhelele T. Oral mucocele/ranula: Another human immunodeficiency virus-related salivary gland disease. Laryngoscope 2015;125:1130–1136. DOI: 10.1002/lary.25058.
Kura MM, Khemani UN, et al. Kaposi's sarcoma in apatient with AIDS. J Assoc Physicians India 2008;56:262–264.
de Moraes M, Vasconcelos M, et al. Solitary Kaposi's sarcoma in retromolar region of an HIV positive patient: case report. J Bras Patol Med Lab 2012;48(1):45–49. DOI: 10.1590/S1676-24442012000100009.
Vieira F, Somerville J, et al. Oral Kaposi's Sarcoma in HIV Positive Patients. A Case Report and a Review of Literature. J AIDS Clin Res 2014;5:349.
Padmapriyadarsini C, Narendran G, et al. Diagnosis & treatment of tuberculosis in HIV co-infected patients. Indian J Med Res 2011;134:850–865. DOI: 10.4103/0971-5916.92630.
Sharma SK, Mohan A, et al. HIV-TB co-infection: epidemiology, diagnosis & management. Indian J Med Res 2005;121:550–567.
Feldman C. Pneumonia associated with HIV infection. Curr Opin Infect Dis 2005;18:165–170.
Kumarasamy N, Vallabhaneni S, et al. Clinical profile of HIV in India. Indian J Med Res 2005;121:377–394.
Monika M, Kaur R, et al. Candida Species Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India. J Pathog 2016;2016:6204804. DOI: 10.1155/2016/6204804.
Anwar KP, Malik A, et al. Profile of candidiasis in HIV infected patients. Iran J Microbiol 2012;4:204–209.