Search

The Research Agenda generated by the 7th World Workshop on Oral Health and Disease in AIDS (WW7) is delivered in this paper. Panels of international experts presided over nine workshops that constituted the conference held in November 2014 in Hyderabad, India. The main goal of the Workshop was to bring together clinician and scientists interested in the subject to debate with world-wide perspectives current issues related to the oral manifestations in HIV/AIDS. The workshops were structured around three themes; basic science, clinical/translational science and social science and were attended by 135 participants from 31 countries. The research questions debated at the workshops are presented in nine consensus papers published in this issue and are summarised in this paper along with an outline of the identified research needs in the field. [ABSTRACT FROM AUTHOR]

HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Surveillance data, however, suggest that one in four people globally living with HIV are unaware of their HIV infection and remains at risk of transmitting their infection if having unprotected sex. A wider array of testing opportunities and settings are thus needed to address this issue of public health significance. Evidence suggests there is a role for the dental team, particularly dentists, in offering chairside point‐of‐care HIV screening to patients during their dental appointments. Dentists, dental hygienists, and other members of the dental team may still have a role in helping to identify new cases of HIV with the goal of improving health outcomes, addressing health inequalities and improving the quality and quantity of life. This paper reviews the global epidemiology of HIV/AIDS, summarizes the point‐of‐care HIV testing process, highlights key findings of international studies (from high‐, middle‐, and low‐income countries) on the role of dental professionals in point‐of‐care HIV testing, and offers suggestions for what additional evidence is needed to make point‐of‐care HIV testing a routine part of dental care. [ABSTRACT FROM AUTHOR]

This paper is based on the last public lecture given by Dr Solomon at the 7th World Workshop on Oral Health & Disease in HIV/AIDS, held in Hyderabad, India, in November 2014. It examines the social impact of HIV in India and the founding of the Y.R. Gaitonde Center for AIDS Research and Education (YRG CARE) clinic in Chennai, India, by Dr Suniti Solomon and her colleagues. This is a story of prejudice and ignorance throughout the various social levels in India. Reports of India's first AIDS case surfaced in 1986, when female sex workers were found to be HIV positive. The first voluntary counseling and testing center, part of a sexually transmitted diseases (STD) clinic, was set up to increase awareness about the epidemic. To address the rapid spread of HIV infection in Tamil Nadu and the existing stigma in society and hospitals, Dr Solomon established YRG CARE in 1993. She recognized that fear and panic about HIV led to widespread social prejudice against HIV-positive patients, even within hospitals. By the end of 2014, over 34 000 patients had accessed these services and 20 000 HIV+ patients had been registered, nearly 40% of whom were females. The team embarked on a statewide awareness program on HIV and sexuality, covering over two hundred schools and colleges educating them about prevention strategies and combating the social stigma attached. The grass-root work of YRG CARE in the management of HIV infections revealed a widespread prejudice, due largely to the lack of awareness about the subject. It is estimated that even in 2015, as little as 40% of HIV-infected people are formally diagnosed and have access to care. In a country as socially and culturally diverse as India, there is much more to be carried out to build on the pioneering work of Dr Solomon. [ABSTRACT FROM AUTHOR]

The interplay between HIV-1 and epithelial cells represents a critical aspect in mucosal HIV-1 transmission. Epithelial cells lining the oral cavity cover subepithelial tissues, which contain virus-susceptible host cells including CD4+ T lymphocytes, monocytes/macrophages, and dendritic cells. Oral epithelia are among the sites of first exposure to both cell-free and cell-associated virus HIV-1 through breast-feeding and oral-genital contact. However, oral mucosa is considered to be naturally resistant to HIV-1 transmission. Oral epithelial cells have been shown to play a crucial role in innate host defense. Nevertheless, it is not clear to what degree these local innate immune factors contribute to HIV-1 resistance of the oral mucosa. This review paper addressed the following issues that were discussed at the 7th World Workshop on Oral Health and Disease in AIDS held in Hyderabad, India, during November 6-9, 2014: (i) What is the fate of HIV-1 after interactions with oral epithelial cells?; (ii) What are the keratinocyte and other anti- HIV effector oral factors, and how do they contribute to mucosal protection?; (iii) How can HIV-1 interactions with oral epithelium affect activation and populations of local immune cells?; (iv) How can HIV-1 interactions alter functions of oral epithelial cells? [ABSTRACT FROM AUTHOR]

Objectives: Significant pain from HIV‐associated sensory neuropathy (HIV‐SN) affects 40% of HIV‐infected individuals treated with antiretroviral therapy (ART). The most salient symptom of the neuropathy is pain, which frequently is moderate‐to‐severe intensity, associated with reduced activities and physical function, sleep disruption, increased severity of depression, and anxiety. Yet, evidence for managing painful HIV‐SN is poor. The purpose of this study was to verify by scientific evidence the neuropathy complication in HIV/AIDS patients to develop effective pain management strategies. Methods: Design: Systematic review. Data sources: PubMed (MEDLINE), Cochrane, www.controlled-trials.com. Selection criteria: the filter "English" was used, timeframed searched was 2009–2019, randomized controlled trials (RCT). Keywords were verified in MeSH "Peripheral Nervous System Disease" and "Antiretroviral Agents" or "Antiretroviral therapy." Review method: the PRISMA flowchart was used. Result: A systematic search following PRISMA guidelines was carried out, and 12 specific articles/studies on the subject were selected. The results revealed that HIV therapy, aging, body mass index, height, and systemic conditions influence neuropathy conditions in HIV/AIDS patients. The multistudies focused on pain management approaches such as administration of pain medication, drug combination to prevent side effects, or ART with minimal side effects. Conclusion: Sensory neuropathy is a frequent complication of HIV infection and ART. An understanding of the mechanism and pathophysiology of neuropathy in HIV is urgently required to develop alternative treatment modalities and to evaluate preventive strategies. [ABSTRACT FROM AUTHOR]

Introduction: Dentists have an important role in reducing new HIV infections by early diagnosis and need to know how to treat patients with HIV and understand universal cross‐infection control. In many parts of the world, healthcare professionals struggle to provide care because of barriers including stigma and cultural attitudes. Aim: To investigate the effectiveness of a brief educational intervention in understanding/changing the views of dental school deans regarding the quality of the oral health and HIV/AIDS teaching and their willingness to undertake a curriculum review if appropriate. Methods: Questionnaires before and after interactive presentation to the deans of 30 Indonesian dental schools and discussion. Results: Only six of 30 dental school deans believed that their HIV undergraduate dental student teaching was inadequate before the intervention, but 29 of 30 deans recognised the need to review their curriculum after the intervention. Whilst the majority (24/30) felt that their HIV teaching was adequate, good or excellent, the majority also thought that their students would find it difficult to treat patients with HIV. Conclusion: The brief educational intervention was effective in improving the understanding/changing the views of dental school deans regarding the quality of HIV/AIDS teaching and learning at their own institution and engaging a willingness to undertake curriculum review. [ABSTRACT FROM AUTHOR]

Objectives: To observe relationships between oral Candida status and salivary human beta‐defensin 2 and 3 (hBD‐2 and hBD‐3) levels in HIV/AIDS patients of Guangxi, China during the first year of antiretroviral therapy (ART) dynamically, and to understand the influence of ART on oral Candida status and salivary hBDs expressions. Methods: A prospective self‐controlled study was carried to observe the dynamic changes of CD4+ T cell counts, oral Candida carriages and salivary hBD‐2,3 expressions in HIV/AIDS patients during the first year of ART. A total of 90 HIV/AIDS patients were enrolled and were examined at the baseline, 3rd, 6th, 12th month of ART. Thirty healthy individuals were enrolled as control. Peripheral blood, oral rinse sample, and unstimulated whole saliva were collected to test CD4+ T cell counts, oral Candida carriages, and hBD‐2,3 expressions. Results: In the first year of ART, CD4+ T cell counts increased significantly. However, oral Candida carriages and oral candidiasis decreased significantly, and salivary hBD‐2 expressions in HIV/AIDS patients decreased gradually, salivary hBD‐3 levels were highly variable. Salivary hBD‐2 concentrations were positively related to oral Candida carriages. Conclusions: The incidence of oral candidiasis among HIV/AIDS patients gradually decreased due to the immune reconstruction of ART. Salivary defensins might play an important role in Candida‐host interaction in HIV/AIDS patients. [ABSTRACT FROM AUTHOR]

The list of immunodeficiency diseases grows each year as novel disorders are discovered, classified, and sometimes reclassified due to our ever-increasing knowledge of immune system function. Although the number of patients with secondary immunodeficiencies ( SIDs) greatly exceeds those with primary immunodeficiencies ( PIDs), the prevalence of both appears to be on the rise probably because of scientific breakthroughs that facilitate earlier and more accurate diagnosis. Primary immunodeficiencies in adults are not as rare as once thought. Globally, the main causes of secondary immunodeficiency are HIV infection and nutritional insufficiencies. Persons with acquired immune disorders such as AIDS caused by the human immunodeficiency virus ( HIV) are now living long and fulfilling lives as a result of highly active antiretroviral therapy ( HAART). Irrespective of whether the patient's immune-deficient state is a consequence of a genetic defect or is secondary in nature, dental and medical practitioners must be aware of the constant potential for infections and/or expressions of autoimmunity in these individuals. The purpose of this review was to study the most common conditions resulting from primary and secondary immunodeficiency states, how they are classified, and the detrimental manifestations of these disorders on the periodontal and oral tissues. [ABSTRACT FROM AUTHOR]

Objective: Secretory leukocyte proteinase inhibitor (SLPI) is an endogenous proteinase inhibitor present in mucosal secretions. It also displays antimicrobial activity including anti-human immunodeficiency virus activity. This protease inhibitor is also expressed in submandibular glands (SMG), but there are few data on its expression in AIDS patients with infectious conditions. Methods: We analyzed the expression of SLPI using immunohistochemistry in submandibular gland samples of 36 AIDS patients [10 with normal histology, 10 with chronic nonspecific sialadenitis, eight with mycobacteriosis, and eight with cytomegalovirus (CMV) infection] and 10 HIV-negative controls. The proteinase inhibitor was quantified using image analysis and expressed as % of positively stained area. Results: There was a higher expression of SLPI in AIDS patients with CMV infection (% of stained area, mean ± SD: 37.37 ± 14.45) when compared with all other groups ( P = 0.009). There were no significant differences between control subjects (22.70 ± 9.42%) and AIDS patients without histologic alterations (18.10 ± 7.58%), with chronic nonspecific sialadenitis (17.13 ± 5.36%), or mycobacterial infection (21.09 ± 4.66%). Conclusion: Cytomegalovirus infection increases SLPI expression in the SMG of AIDS patients. Our results reveal new insights into the pathogenic association between HIV and CMV in AIDS patients. [ABSTRACT FROM AUTHOR]

AIM: To show that sublingual ranula is associated with HIV/AIDS and as such should be considered an HIV/AIDS associated oral lesion in Zimbabwe. OBJECTIVES: To retrospectively study the prevalence, age and gender distribution, the HIV serostatus of ranula patients and the trend in prevalence of ranula and Kaposi's sarcoma (KS) in patients at the two largest referral Oral and Maxillofacial Surgery specialist centres in Harare, Zimbabwe. To use this information to infer an association between ranula and HIV/AIDS in Zimbabwe. DESIGN: Descriptive study with a retrospective and prospective component. SETTING: Oral and Maxillofacial Surgical clinics at specialist referral hospitals, Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. SUBJECTS: Eighty-three cases of ranula were studied: 45 cases retrospectively and 38 consecutively. A total of 231 cases of KS were studied retrospectively. METHODS: Histopathologic records of patients who presented with ranula and KS during the period January 1981 to September 2003 were studied. Gender and age were recorded for each case. Thirty-eight ranula patients studied consecutively during the period June 1999 to September 2003 were consented for HIV testing. RESULTS: There were 83 cases of ranula; 43.4% male and 56.6% female. There were 231 cases of KS, 61.2% male and 38.8% female. Male to female ratio was 1:1.3 for ranula and for KS was 1:0.6. Ranula was predominant in the 0–10 year age group (73.5%) while KS was most common in the 21­40 year age group (76.4%). Ranula and KS both had a marked rise in prevalence from 1992 to 2003. A total of 88.5% of the ranula cases tested HIV positive with 95% in the 0­10 year age group. CONCLUSION: There was a rising prevalence of ranula which mirrors that of KS (an HIV/AIDS associated oral lesion) and that 88.5% of ranula patients were HIV positive with 95% of them in the 0­10 year age group. Sublingual ranula should thus be considered another HIV/AIDS associated lesion in Zimbabwe, especially in children. [ABSTRACT FROM AUTHOR]

The reasons that some past infections, including smallpox and diphtheria, have been conquered or controlled will be explored, as will the reasons that some other infections such as tuberculosis and leprosy remain a problem. At present HIV remains a major problem. All antiretroviral drugs are viristatic and thus, even in combination, not curative. Killing HIV will require a ’guided missile’ drug that will penetrate every infected cell to remove the HIV-directed DNA within the host genome and this will not be possible, I predict, for decades. Even if a vaccination were available there will be numerous practical problems. The reasons why Edinburgh (incorrectly) received the accolade ’The AIDS Capital of Europe’ will be explored and dismissed as a media creation. In the future influenza will cause a world pandemic (the question is not if, but when). Drug resistant infections will continually develop in, and be spread from, hospitals. Most bacteria divide rapidly and it is surprising that drug resistance takes so long to develop. Jet travel will allow infections to spread to anywhere on the globe within 36 h. The fact that HIV and similar retroviruses insert themselves into host cell genomes, and that these sequences can thereafter function genetically, raises the possibility that some genetic disorders were originally infections and also that such inheritance of acquired characteristics opens the door for genetic manipulation which has implications for manipulation of Darwinian evolution in humans and their pathogens. [ABSTRACT FROM AUTHOR]