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      Oral Manifestations in HIV/AIDS-Infected Children

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          Abstract

          Objectives:

          To assess factors influencing the distribution of oral manifestations in HIV/AIDS-infected children attending the Paediatric Infectious Disease Clinic in Mulago Hospital, Kampala.

          Methods:

          This was a cross-sectional study comprising 237 children (males/females: 113/124) aged 1 to 12 years. The parents/guardians were interviewed to obtain demographic information, oral hygiene practices, dietary habits and health seeking behaviours as well as any medications taken. The children were clinically examined for oral lesions based on World Health Organization criteria with modifications.

          Results:

          About 71.7% of the children cleaned their teeth. About 16.9% of the children had visited a dentist since birth, mainly for emergency care. One or more oral lesions were recorded in 73% of the children of whom 19.0% experienced discomfort during oral functions. Cervical lymphadenopathy, oral candidiasis and gingivitis were the most common soft tissue oral lesions: 60.8%, 28.3% and 19.0%, respectively. Except for dental caries, the overall frequency distribution of soft tissue oral lesions was significantly lower in children on highly active antiretroviral therapy (HAART) as compared to their counterparts not on HAART. The prevalence of dental caries in deciduous and permanent dentitions was 42.2% and 11.0%, respectively. Tooth brushing and previous visits to the dentist were indirectly and significantly associated with dental caries. About 5.9% (n=14) of the children had <200 CD3 + CD4 T-lymphocyte cells per μl of blood.

          Conclusions:

          The majority of the children had one or more oral lesions, particularly in the group not on HAART. Some of the lesions were associated with discomfort during oral functions.

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          Most cited references 36

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          Oral Health surveys. Basic Method

          (1997)
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            Decline in the rate of oral opportunistic infections following introduction of highly active antiretroviral therapy.

            In recent years the management of human immunodeficiency virus (HIV)-positive individuals has been based on highly active antiretroviral therapy (HAART) comprising a combination of nucleoside analogues or the combination of these agents with protease inhibitors. The aim of the present study was to describe the prevalence of oral lesions in a cohort of 103 HIV-seropositive patients on HAART, to compare these data with the prevalence of lesions prior to HAART and to correlate these finding with the immunologic data. A total of 103 HIV-seropositive patients on HAART were selected. Oral lesions associated with HIV infection and immunological parameters were registered. On re-examination 6 months after the first evaluation, 61/103 patients were available. Comparing the prevalence of oral lesions before and after the onset of HAART, the number of oral lesions was significantly lower (P=0.001). The number of CD4+ cells increased and the viral load decreased significantly after initiation of HAART (P=0.001 and P= 0.0001). On re-examination 6 months later, the prevalence of lesions again decreased significantly (P=0.001). The immunological benefits of HAART may prevent HIV-associated oral lesions in patients with advanced HIV disease. Our results showed that oral manifestations decrease on HAART, but in four patients the immunological effects of therapy did not provide sufficient protection against human papillomavirus (HPV)induced lesions.
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              Increased prevalence of malaria in HIV-infected pregnant women and its implications for malaria control.

              To examine in pregnant women the relationship between HIV infection and malaria prevalence and to determine, in relation to HIV infection, the effectiveness of sulphadoxine-pyrimethamine in clearing P. falciparum infection. Descriptive cross-sectional analysis of P. falciparum prevalence in pregnant women at first antenatal visit and of women at delivery who had received two sulphadoxine-pyrimethamine treatments for malaria. HIV status was assessed in 621 women who attended for antenatal care and for delivery at two rural hospitals in southern Malawi in 1993-94. Information was collected on maternal age, parity and gestational age. Prevalence of P. falciparum was measured at first antenatal visit and delivery. Women were given two routine treatment doses of sulphadoxine-pyrimethamine (SP), at first antenatal visit and between 28 and 34 weeks gestation, conforming to Malawi government policy on antimalarial control during pregnancy. Prevalence of HIV infection was 25.6% and all infections were HIV type-1. In primigravidae malaria prevalence at recruitment was 56.3% in HIV-infected and 36.5% in HIV-uninfected women (P=0.04). The corresponding figures for multigravidae were 23.8% and 11.0%, respectively (P 3), indicating parity-specific immunity to malaria was impaired. Malaria prevalence at delivery remained high in HIV-infected women despite prior routine treatment with sulphadoxine-pyrimethamine in pregnancy There was no significant difference in parasite prevalence at delivery between women who did or did not use sulphadoxine-pyrimethamine. HIV infection is associated with a significant increase in malaria prevalence in pregnant women of all parities with the effect apparent from early in gestation. Two treatment doses of sulphadoxine-pyrimethamine were inadequate to clear parasitaemia in many women by the time of delivery and this occurred independently of HIV status and despite high sensitivity to SP in this area. There is a need to undertake longitudinal studies to determine the incidence of P. falciparum infection in HIV-infected and uninfected pregnant women and to reassess the frequency and timing of sulphadoxine-pyrimethamine treatment doses in these women. Late pregnancy re-infections with P. falciparum probably explain the high parasite prevalence at delivery following sulphadoxine-pyrimethamine treatment at 28-34 weeks gestation.
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                Author and article information

                Journal
                Eur J Dent
                Eur J Dent
                European Journal of Dentistry
                Dental Investigations Society
                1305-7456
                1305-7464
                July 2011
                : 5
                : 3
                : 291-298
                Affiliations
                [a ] Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
                [b ] Paediatric Infectious Disease Clinic, Mulago Hospital, Kampala, Uganda
                Author notes
                Corresponding author: Charles Mugisha Rwenyonyi, Department of Dentistry, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda. Phone: (256) 414-532803, E-mail: mrwenyonyi@ 123456chs.mak.ac.ug
                Article
                dent05_p0291
                3137442
                21769270
                Copyright 2011 European Journal of Dentistry. All rights reserved.
                Categories
                Original Articles

                Dentistry

                hiv/aids-infected children, oral manifestations, uganda

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