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      Oral Complications of HIV Disease

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          Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.

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          Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study.

          Evidence on the effectiveness of highly active antiretroviral therapy (HAART) for HIV-infected individuals is limited. Most clinical trials examined surrogate endpoints over short periods of follow-up and there has been no placebo-controlled randomised trial of HAART. Estimation of treatment effects in observational studies is problematic, because of confounding by indication. We aimed to use novel methodology to overcome this problem in the Swiss HIV Cohort Study. Patients were included if they had been examined after January 1996, when HAART became available in Switzerland, were not on HAART, and were free of AIDS at baseline. Cox regression models were weighted to create a statistical population in which the probability of being treated at each time point was unrelated to prognostic factors. Low CD4 counts and increasing HIV-1 viral load were associated with increased probability of starting HAART. Overall hazard ratios were 0.14 (95% CI 0.07-0.29) for HAART compared with no treatment, and 0.49 (0.31-0.79) compared with dual therapy. Compared with no treatment, HAART became more beneficial with increasing time since initiation but was less beneficial for patients whose presumed mode of transmission was via intravenous drug use (hazard ratio 0.27, 0.12-0.61) than for other patients (0.08, 0.03-0.19). Our results, which are appropriately controlled for confounding by indication, are consistent with reported declines in rates of AIDS and death in developed countries, and provide a context in which to consider adverse effects of HAART.
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            Acute human immunodeficiency virus type 1 infection.

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              HIV-1 pathogenesis.

              Despite considerable advances in HIV science in the past 20 years, the reason why HIV-1 infection is pathogenic is still debated and the goal of eradicating HIV-1 infection remains elusive. A deeper understanding of the interplay between HIV-1 and its host and why simian immunodeficiency virus (SIV) is nonpathogenic in some natural hosts may provide a few answers.

                Author and article information

                Clinics (Sao Paulo)
                Clinics (Sao Paulo, Brazil)
                Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                May 2009
                : 64
                : 5
                : 459-470
                [I ] Departamento de Clinica e Odontologia Preventiva, Universidade Federal de Pernambuco - Recife/PE, Brazil
                [II ] Oral Medicine, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, UCL Eastman Dental Institute - London, UK
                Author notes
                Email: jleao@ , Tel.: 55 81 2126.8818
                Copyright © 2009 Hospital das Clínicas da FMUSP


                oral manifestations, oral diseases, mouth, hiv, aids


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