249092 Contemporary profile of oral manifestations of HIV/AIDS and associated risk factors in a Southeastern US clinic

Monday, October 31, 2011

Irene Tami-Maury, DrPH, DMD, Msc , MD Anderson Cancer Center, The University of Texas, Houston, TX
James H. Willig, MD , University of Alabama at Birmingham, Med-Infectious Disease, Birmingham, AL
Sten Vermund, MD, PhD , School of Medicine, Institute for Global Health, Vanderbilt University, Nashville, TN
Pauline Jolly, PhD, MPH , Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
Inmaculada Aban, MS, PhD , Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
Jeffrey Hill, DMD , Department of Comprehensive Dentistry, University of Alabama School of Medicine, Birmingham, AL
Craig Wilson, MD , Sparkman Center for Global Health, University of Alabama at Birmingham, Birmingham, AL
Background: Introduction of highly active antiretroviral therapy (HAART) has resulted in a significant decrease of oral manifestations (OM). The profile and risk factors for OM in those individuals initiating HAART remains understudied in the Southeast of the US, region of increasing HIV prevalence. Objective: To determine clinical, socio-demographic and laboratory characteristics associated with the presence of OM among patients initiating HAART. Methods: Retrospective review of electronically captured data from patients initiating HAART at a Southeastern US clinic. Prevalence was determined and risk factors for overall OM, oropharyngeal candidiasis (OPC), and all other OM were evaluated using logistic regression. Results: In our study sample (n=744), majority of individuals were males (75%), African-American (50%), mean age of 39 years, 42% of which reported sex with men (MSM). 266 had some type of OM. Compared to those without any OM, patients with OM had a lower mean baseline CD4+ T cells count (CD4 count) (331260 vs. 179244 CD4 cells/mm3) and higher mean baseline HIV-1 RNA viral load (4.01.34 log10 vs. 4.61.30 log10) (p<0.01). In the logistic regression models seeking to determine factors associated with an increased risk of OM and OPC, the only characteristic associated with the outcome was baseline CD4 value. Being male, African-American and heterosexual showed a protective role for OM other than OPC. Conclusion: OM continues to be common despite HAART. General OM and OPC were closely associated with a low baseline CD4 count. Knowledge of risk factors for OM can potentially help clinicians target oral evaluation of HIV individuals.

Learning Areas:
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs

Learning Objectives:
- Explain how some socio-demographic profiles have been historically associated with high poverty rates which limits the ability of HIV positive individuals to access health care, including dental care. - Identify clinical, socio-demographic, and laboratory characteristics associated with the presence of oral manifestations among HIV patients initiating anti-retroviral therapy in a Southeastern US clinic. - Discuss the need of implementing strategies for dental/oral training of health professionals, or integrate dentists into the HIV care team, in order to increase the accuracy of the diagnosis and treatment implementation of oral lesions in the HIV population.

Keywords: HIV/AIDS, Oral Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because this study was part of my doctoral dissertation research. I am the principal investigator of this study. For more than ten years I have been involved in educational, research, and service activities related to oral health and HIV infection.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.