Oral and Dental Health in People Living with HIV and Additional Non-Communicable Diseases

Center for Clinical Research

Division of Extramural Research, NIDCR

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This concept will encourage research to address gaps in our knowledge of oral and dental health status of people living with HIV (PLWH) especially PWLH who also have additional non-communicable diseases (NCDs).  It will support efforts to understand the combined effects of HIV, antiretroviral therapy (ART), and NCDs on oral health, and it will encourage identification of approaches for prevention and treatment of oral diseases and assessment of treatment outcomes in PLWH with or without NCDs. These efforts could help to generate evidence for dental treatment guidelines tailored to the needs of dental patients with HIV.

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The introduction of ART has significantly improved survival among PLWH. HIV surveillance data from 2011 to 2016 indicate that the number of PLWH aged 50 years and older has increased in the United States while the annual rate of new HIV diagnoses in this age group has decreased 1. Life expectancy of PLWH is now close to that of HIV-negative individuals if treatment starts early after diagnosis2. However, PLWH have increased rates of age-related NCD compared to HIV-negative individuals in the same age range3, such as cardiovascular diseases4, neurocognitive disorders5, osteoporosis6, kidney7 and liver diseases8 and malignancies9.  The differences in the NCD rates between PLWH and HIV-negative individuals could be due to the HIV infection itself, exposure to ART, multiple morbidities, high rates of risky behaviors, differences in socioeconomic and demographic factors, and other factors including accelerated aging3, 10. In addition, there is evidence of accelerated age-related inflammation in PLWH, which may contribute to prevalence and severity of NCDs11.

Some oral diseases (e.g. caries, periodontal diseases, xerostomia and salivary glands dysfunction, oral cavity coinfections, oral and pharyngeal malignancies) are more prevalent and severe in PLWH compared to HIV-negative individuals12-13.  A multi-center international study in west Africa evaluated caries in children ages 5-15. Four hundred and twenty HIV infected children on ART were compared to 418 HIV non-infected siblings. The median index for missing or filled permanent and primary teeth surfaces (DMFdefS) was 7 for the HIV-infected children and 2 for the uninfected siblings14. A recent study evaluated oral complaints of PLWH visiting the outpatient clinic at the University of California. The study included a small convenience sample of patients that have access and use oral and dental care on a regular basis. Yet 62.9% of the patients reported at least one dental complaint in the past year15. It is not known if infection with HIV or exposure and extended use of ART affects the prevalence and severity of oral diseases16. The rates of disease may also be related to demographic characteristics of the population and presence of other oral disease risk factors (e.g., history of tobacco use, nutritional status and dietary history). The extent to which NCDs such as diabetes and cardiovascular disease contribute to oral disease in PLWH is difficult to measure, and the relative importance and potential interactions of all these factors have not been determined.

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Gaps and Opportunities

Oral diseases are more prevalent and severe in PLWH than in HIV-negative individuals. However, knowledge gaps exist about the prevalence, severity, treatment approaches and treatment outcomes of oral and dental diseases in PLWH who also have additional NCDs

To help characterize oral diseases in PLWH, this concept will encourage studies to compare oral disease status among PLWH without NCDs, PLWH with NCDs, and HIV-negative individuals with NCDs, studying populations with similar sociodemographic characteristics to control for the influence of these variables. This concept will also support studies to assess treatment outcomes for oral diseases and conditions in PLWH with and without NCDs.

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Specific Areas of Interest

This concept will encourage research to examine and compare oral and dental health status and oral health care in PLWH without NCDs, PLWH with NCDs and HIV-negative individuals with NCDs with similar sociodemographic background, including research to:

  • Establish the extent and progression of caries and periodontal disease,
  • Examine extent and progression/regression of pre-malignant and malignant oral lesions,
  • Examine dental implant success or failure,
  • Define and reliably assess the extent and natural history of osteonecrosis and osteoradionecrosis of the jaw,
  • Characterize and evaluate oral disease prevention approaches,
  • Assess the effectiveness of standard of care treatment, and
  • Assess long-term successes of different treatment and restorative approaches.
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  1. Centers for Disease Control and Prevention. Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas, 2011–2016. HIV Surveillance Supplemental Report 2018;23(No. 5). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.  Published August 2018. Accessed 13/08/2018.
  2. Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017 Aug;4(8): e349-e356.
  3. Escota GV, O'Halloran JA, Powderly WG, Presti RM. Understanding mechanisms to promote successful aging in persons living with HIV. Int J Infect Dis. 2018 Jan; 66:56-64.
  4. A.J. Rodger, R. Lodwick, M. Schechter.  Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS, 27 (2013), pp. 973-979. 
  5. D.B. Clifford. HIV-associated neurocognitive disorder.  Curr Opin Infect Dis, 30 (2017), pp. 117-122.
  6. R. Guerri-Fernandez, P. Vestergaard, C. Carbonell, et al.HIV infection is strongly associated with hip fracture risk, independently of age, gender, and comorbidities: a population-based cohort study. J Bone Miner Res, 28 (2013), pp. 1259-1263.
  7. P. Campos, A. Ortiz, K. SotoHIV and kidney diseases: 35 years of history and consequences Clin Kidney J, 9 (2016), pp. 772-781.
  8. S.E. Kellerman, D.L. Hanson, A.D. McNaghten, P.L. Fleming. Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in human immunodeficiency virus-infected subjects J Infect Dis, 188 (2003), pp. 571-577.
  9. M.J. Silverberg, B. Lau, C.J. Achenbach, et al.Cumulative incidence of cancer among persons with HIV in North America: a cohort study. Ann Intern Med, 163 (2015), pp. 507-518.
  10. S. Pathai, H. Bajillan, A.L. Landay, K.P. High. Is HIV a model of accelerated or accentuated aging? J Gerontol A Biol Sci Med Sci, 69 (2014), pp. 833-842.
  11. Arielle N. Valdez, Leah H. Rubin, and Gretchen N. Neigh. Untangling the Gordian knot of HIV, stress, and cognitive impairment. Neurobiol Stress. 2016 Oct; 4: 44–54.
  12. Arrive E, Meless D, Anaya-Saavedra G, Gallottini M, Pinzon LM, Ramirez-Amador V. The global burden of oral diseases in pediatric HIV-infected populations: a workshop report. Oral Dis. 2016 Apr;22 Suppl 1:149-57.
  13. Johnson NW.The mouth in HIV/AIDS: markers of disease status and management challenges for the dental profession. Aust Dent J. 2010 Jun;55 Suppl 1:85-102.
  14. Rajonson N, Meless D, Ba B, Faye M, Diby JS, N'zore S, Datté S, Diecket L, N'Diaye C, Aka EA, Kouakou K, Ba A, Ekouévi DK, Dabis F, Shiboski C, Arrivé E. High prevalence of dental caries among HIV-infected children in West Africa compared to uninfected siblings. J Public Health Dent. 2017 Jun;77(3):234-243.
  15. Trevillyan JM, Chang JJ, Currier JS. Prevalence of dental symptoms and access to dental care in an American HIV outpatient clinic. Oral Dis. 2018 Jul;24(5):866-867.
  16. Vernon LT, Jayashantha P, Chidzonga MM, Komesu MC, Nair RG, Johnson NW. Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report.Oral Dis. 2016 Apr;22 Suppl 1:135-48.
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Last Reviewed
September 2018