ORAL MANIFESTATIONS OF HIV INFECTION: A STUDY IN A FRENCH HOSPITAL

Abstract

Background: HIV infected patients may present with oral problems related to immunosuppression, smoking, alcohol, drugs or poor oral hygiene. Antiretroviral drugs used to effectively treat HIV infection mean that morbidity and mortality from opportunistic infections have significantly decreased.

Aims: This observational study was conducted on the oral status of HIV infected patients, treated in hospital day care (ethics committee N° 11-039). We compared the prevalence of oral pathologies by disease stage and analysed oral manifestations according to CD4+ T-cell counts and oral hygiene. Chisquare tests were used and significance level was p<0.05.

Results: 60 patients were enrolled during 10 months, 55% (n = 33) women (mean age: 44.3 years); 65% had no dental practitioner. CD4 T-cell counts fell below 200/μL in 10% (n = 6) patients. About 62% of patients had an undetectable viral load and 87% received triple therapy; around 44% of patients presented oral manifestations and 23.5% (n = 14) had a plaque index > 50%. There were no significant correlation between oral lesions and disease stages (p=0.58), or CD4 T-cell counts (p=0.92). However, oral lesions were strongly correlated with poor hygiene (p<0.001). Discussion: Many publications highlight the decrease of oral lesions in triple therapy patients. These are often seen in patients without medical follow up or with discontinuous care, typically with insecure situations and social isolation. They are often rejected by private practitioners, hospital being their last option. Prescription of antiretroviral drugs and treatment of opportunistic infections could explain the lack of correlation between HIV infection and oral pathologies.

Conclusion: These results show that regular medical and dental follow up leads to a decrease in the incidence of HIV oral manifestations. The positive assessment of this hospital study encouraged us to create a systematic dental consultation for HIV infected patients. So, care could continue, especially in underserved and isolated people.