HAART has positive impact on HIV-associated oral pathology
MedWire News: The use of highly active antiretroviral therapy (HAART) for HIV infection markedly reduces the risk for oral mucosal lesions, Chinese researchers believe.
They say that lesions such as oral Kaposi's sarcoma affect around one-quarter of patients on HAART, representing a significant reduction in rates compared with the pre-HAART era.
In this cross-sectional study, Peter Tsang (The University of Hong Kong) and team estimated the prevalence of oral mucosal lesions in 101 HIV-infected ethnic Chinese patients living in Hong Kong and 83 HIV-negative control individuals matched for age and gender.
The patients had been receiving HAART for at least 24 months, with the majority (72.3%) taking nucleoside reverse transcriptase inhibitors (most often zidovudine plus lamivudine), 29.7% taking non-nucleoside reverse transcriptase inhibitors (most often nevirapine), and 14.9 taking protease inhibitors (usually lopinavir plus ritonavir).
At the time of examination, 24.8% of the cohort had one or more oral mucosal lesion. Specific diagnoses included oral hairy leukoplakia, oral ulceration, parotid enlargement, Kaposi's sarcoma, linear gingival erythema, lichen planus, hyperpigmentation, and angular cheilitis.
Surprisingly there were no cases of oral candidiasis, note the researchers.
The prevalence of oral mucosal lesions was not associated with the type of antiretroviral therapy, route of HIV transmission, or plasma viral load, report Tsang et al in the Journal of Investigative and Clinical Dentistry.
Interestingly, however, the prevalence of lesions varied with CD4 count, with the highest burden of oral pathology seen in patients with an intermediate count (200‑500 CD4 cells/µL) and the lowest burden in those with a high count (>500 CD4 cells/µL).
Oral pathology (30.4%) was still observed even in patients with a low or undetectable CD4 count, however.
Finally, salivary flow rates were significantly lower in HIV-infected patients than in healthy controls (0.37 vs 0.49 mL/min), as was salivary pH (7.1 vs 7.5), although the latter difference did not reach statistical significance.
Salivary flow rate did not differ by HAART regimen, CD4 count, HIV viral load, or salivary pH, the authors add.
Commenting on their findings, the authors note that oral manifestations have traditionally been regarded as predictors of failure of long-term HAART.
"However, the data from our patient group suggest that these concepts should be interpreted carefully after determining the type of lesion and other parameters, such as CD4 counts or HIV viral load," they remark.
They conclude: "Although this patient cohort did not show low salivary flow-related complications, our data suggest the importance of periodic dental check-ups, the implementation of rigorous oral hygiene measures, fluoride treatment, and additionally, be vigilant for malignant conditions, such as Kaposi's sarcoma, even with newer HAART regimens."
By Joanna Lyford