DENTAL MANAGEMENT OF A PATIENT WITH HIV/AIDS WILKINS CH4 DH201 Clinician Sciences III Lisa Mayo, RDH, BSDH

HIV-1 Infection General facts Severe pandemic disease caused by HIV infection First recognized in 1981 as loss of cellular immunity HIV-1 (more prevalent in U.S. & Europe, focus of CH4) HIV-2 Transmission: semen, vaginal secretions, breast milk, blood DIAGNOSTIC Serological tests 1. EIA/ELISA: highly sensitive & specific, widely used 2. Western Blot: done to confirm ELISA 3. IFA; done to confirm ELISA PROGRESSION testing T-cell % or ratios

Review The majority of cases of transmission of HIV in adults is due to which of the following? A) Blood transfusion B) Needle sharing C) Sexual contact D) Contact with saliva

Review The majority of cases of transmission of HIV in adults is due to which of the following? A) Blood transfusion B) Needle sharing C) Sexual contact D) Contact with saliva

Enveloped virion 2 strands of RNA

Immunology: 2 Systems Protect Us Cell-Medicated & Humoral Immunity 1. Cell-Mediated Immunity: T-Cells (more next slide) Thymus: where T-cells mature Regulation of antibody response Release cytokines: lymphokines, interluekins 2. Humoral antibody mediated immunity: B-cells Ex: Monocytes, PMN, Dendritic Cells, Natural Killer Cells, Eosinophil Antibodies Immunoglobulins that react specifically with antigen Gamma globulins (IgG, IgA, IgM, IgE)

PMN Monocyte NKC Basophil Eosinophil

Immunology: Cell-Mediated Cell-Mediated Immunity 1. CD4-T Helper T-cells Infected w/ HIV/AIDS = # ↓ Lead attack against infections 2. CD8 Suppressor/Cytotoxic T-cells Directly attack & kill diseased cells End the immune response

End immune response Body not able to distinguish HIV from other cells

Question Cell mediated immunity is associated with ______ while humoral immunity is _______. a. B cells, plasma cells b. B cells, T cells c. Plasma cells, T cells d. T cells, B cells

Answer Cell mediated immunity is associated with ______ while humoral immunity is _______. a. B cells, plasma cells b. B cells, T cells c. Plasma cells, T cells d. T cells, B cells

HIV/AIDS T-Count When HIV infects humans, the cells it infects most often are CD4 cells The virus becomes part of the cells, and when they multiply to fight an infection, they also make more copies of HIV Infected with HIV for a long time = # CD4 cells they have goes down Sign that the immune system is being weakened Lower CD4 count = more likely the person will get sick

HIV/AIDS T-Count CD4 cell values change throughout the day Reported as the # of cells in a cubic millimeter of blood (mm3) Normal CD4 counts = (↓ 200 = AIDS) Normal CD8 counts = T-cell % used by health care professionals to determine overall health of patients Normal T counts = 20-40% ↓14% = severe immune damage = pt has AIDS Ratio CD4:CD8 cells Healthy people = ratio is to 2 CD4 cells for every CD8 cell HIV = more CD8 cells than CD4 cells so ratio varies from norm

NBQ HIV attaches to which of the following cells? a. B-Lymphocytes b. Suppressor T-Lymphocytes c. Helper T-Lymphocytes d. Neutrophils e. Platelets

NBQ HIV attaches to which of the following cells? a. B-Lymphocytes b. Suppressor T-Lymphocytes c. Helper T-Lymphocytes d. Neutrophils e. Platelets

Clinical Course of HIV-1 Seroconversion = when antibody can be detected in blood for first time 6wks-6mo after exposure Incubation period Range from time infection – AIDS symptoms Could be 15+yrs Acute seroconversion syndrome More than 500 CD4+ T lymphocytes Detectable HIV antibody may be found as a serum marker of disease

Clinical Course of HIV-1 Early symptomatic HIV+ CD cells Continued ↑ in viremia Systemic symptoms: night sweats, weight loss, diarrhea, fever, malaise, general weakness, opportunistic infections, oral lesions more common Late-stage disease: AIDS CD4 below 200 Pneumonia, AIDS-dementia complex, Tuberculosis, Neoplasms, HIV-wasting syndrome (Constitutional disease) Death 1-3yrs (if untreated)

NBQ The immunological indication that signifies a patient has AIDS is a. Suppression of humoral immunity b. Suppression of cellular immunity c. Loss of neutrophil production d. Loss on monocytes

NBQ The immunological indication that signifies a patient has AIDS is a. Suppression of humoral immunity b. Suppression of cellular immunity c. Loss of neutrophil production d. Loss on monocytes

NBQ Which cell in the immune system is changed, replicated and destroyed in HIV/AIDS? a. T-4 (T-helper lymphocytes) b. T-8(T-supressor lymphocytes) c. HTLV-III d. Retrovirus

NBQ Which cell in the immune system is changed, replicated and destroyed in HIV/AIDS? a. T-4 (T-helper lymphocytes) b. T-8(T-supressor lymphocytes) c. HTLV-III d. Retrovirus

HIV/AIDS Manifestations

Extraoral Lymphadenopathy Skin lesions: Kaposi’s sarcoma, zoster, HPV Intraoral Candida Hairy leukoplakia Oral warts Angular cheilitis Recurrent herpes Kaposi sarcoma Opportunistic infections Tooth erosion from frequent vomiting/nausea Xerostomia from meds Increased caries Perio (next slide)

HIV/AIDS Manifestations Perio Progress more rapidly, more severe symptoms 1. Linear gingival erythema Band of erythema at free gingival margin, 2-3mm apically Not always related to biofilm presence 2. NUP Attachment loss of 6mm in 6mo common

HIV/AIDS Tx Considerations Palliative care for infections Respect, kindness, compassion Avoid creation of aerosols ONLY to protect the PATIENT Universal precautions Meds have many side effects Collaborate w/MD for blood tests CD4 lymphocyte count or % CD4:CD8 Viral load, platelet count, prothrombin time May need premed More frequent RC

NBQ Identify a procedure used when treating HIV/AIDS patients: a. Double glove b. Disposable barriers c. Appoint as the last patient of the day d. Sterilize instruments then clean in ultrasonic and sterilize again

NBQ Identify a procedure used when treating HIV/AIDS patients: a. Double glove b. Disposable barriers c. Appoint as the last patient of the day d. Sterilize instruments then clean in ultrasonic and sterilize again