1. 5/8/2018

2. Pathology and Management of Periodontal Problems
in Patients with HIV Infection
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5/8/2018

3. ORAL AND PERIODONTAL MANIFESTATIONS Oral Candidiasis
Oral Hairy Leukoplakia
Kaposi's Sarcoma and Other Malignancies
Bacillary (Epithelioid) Angiomatosis Oral
Hyperpigmentation
Atypical Ulcers
GINGIVAL AND PERIODONTAL
DISEASES Linear Gingival Erythema
Necrotizing Ulcerative Gingivitis
Necrotizing Ulcerative Periodontitis
Necrotizing Ulcerative Stomatitis
Chronic Periodontitis
PERIODONTAL TREATMENT PROTOCOL
Health Status
Infection Control Measures
Goals of Therapy
Maintenance Therapy
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4. HIV infected patients
In humans, HIV depletes CD4+ lymphocytes (T helper cells) which leads to the development of a variety of fungal, viral, and bacterial oral infections. Oral manifestations of HIV infection have been used to stage HIV disease ,identify prophylactic treatment of other serious infections and indicate disease prognosis.
HAART: highly active antiretroviral therapy
Increase CD4+ cell count
Decrease HIV RNA
Extends AIDS free survival
Decrease inflammation
Activates immune system
Higher rates of CVDs
Toxic side effects
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5. Oral and Periodontal diseases strongly associated with HIV infection
Seven cardinal oral lesions:
Oral Candidiasis
OHL: oral hairy leukoplakia
KS: kaposi sarcoma
Non-Hodgkin lymphoma
LGE: linear gingivitis erythema
NUG: necrotizing ulcerative gingivitis
NUP: necrotizing ulcerative periodontitis
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6. Candidiasis Oral candidiasis: 39.3% erythematous candidiasis: 39.3%
The mean CD4 count of patients
with oral lesions (207 cells/mm(3))
without oral lesions (291 cells/mm(3)) .
Oral candidiasis was found to be significantly correlated to a reduced CD4 cell count below 200 cells/mm.
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J Oral Sci Jun;53(2):203-11

7. Oral Hairy Leukoplakia
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8. Kaposi Sarcoma
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9. Non-Hodgkin Lymphoma
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10. Abnormal Herpetic Lesions
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11. Aphthous Ulcer
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12. Periodontal diseases strongly associated with HIV infection
Seven cardinal oral lesions:
Oral Candidiasis
OHL: oral hairy leukoplakia
KS: kaposi sarcoma
Non-Hodgkin lymphoma
LGE: linear gingivitis erythema
NUG: necrotizing ulcerative gingivitis
NUP: necrotizing ulcerative periodontitis
5/8/2018

13. Prevalence of periodontal diseases
Age
Immune system competence
Smoking
Oral hygiene level
A significant decrease of the overall prevalence of oral lesions from
47-85% to 32-46% before and after introduction of HAART
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14. LGE formerly known as HIV associated gingivitis
A 2-3 mm marginal band of intense erythema in the free gingiva (Winkler et al. 1988).
it is more commonly a generalized gingival condition.
Relationship of periodontal pathogens and the local host response.
does not respond to conventional scaling, root planing, and plaque control,
Candida species have been identified with LGE.
Reduced proportions of T cells and macrophages and an increased number of IgG plasma cells and PMNs.
With the advent of antiretroviral therapy for HIV positive patients, the prevalence of HlV-specific lesions has been dramatically reduced; even so, plaque accumulation with reduced CD4+ counts will still account for a pronounced gingival inflammatory response.(9-50%)
5/8/2018

15. NPD
The disease seems to occur slightly more often among HlV-infected individuals.
prevalences of NPD between 0% and 27.7%. However, most studies have included cohorts of individuals connected with hospitals or dental clinics.
NP was found in 1% of 200 HlV-seropositive individuals in Washington, DC, this is particularly true after introduction of antiretroviral therapy (Tappuni & Flemming 2001).
The clinical signs of NG/NP are similar in HIV-seropositive and -seronegative patients, and are not related to CD4+ T-cell count, to neutrophil count, to gender, or to age.
AIDS Res Treat. 2011;2011: Epub 2011 Jun 21.
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16. NUP
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17. NUS
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18. Healthy periodontium is not surprising in well controlled
HIV infected patients
Of the 54 samples cultured from HIV-positive patients,
44 (82%) were positive for yeast species,
19 (48%) patients were positive for Candida dubliniensis,
This study reports for the first time the recovery of C. dubliniensis from subgingival intraoral sites and confirms the presence of Candida species in sites of periodontal disease associated with HIV.
J Clin Microbiol Dec;39(12):
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19. Treatment Strategy HIV-infected subjects without HAART
showed greater risks of having orofacial pain, oral dryness, oral lesions, and
periodontal pockets than those with short-term HAART (P < 0.01).
The subjects with long-term HAART
have a greater risk of having oral lesions than those with short-term HAART
(P < 0.05).
long-term HAART has adverse effects on oral health status of HIV-infected subjects.
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J Oral Pathol Med May;39(5):

20. Treatment Strategy
Chronic gingivitis (43.8%) was the most frequent in all subjects.
A clear improvement in gingival health was registered in 78.2% of subjects after six months of mechanical therapy.
No association was registered between CD4 count and gingival/periodontal status or attachment loss with HIV staging.
CONCLUSIONS:
Oral hygiene using mechanical therapy improves the gingival condition, suggesting that it is an important step in the maintenance of periodontal health.
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Med Oral Patol Oral Cir Bucal Mar 1;15(2):e

21. Treatment Strategy IRIS hypothesis:
P. gingivalis could induce HIV-1 reactivation via chromatin modification and that butyric acid, one of the bacterial metabolites, is responsible for this effect.
These results suggest that periodontal diseases could act as a risk factor for HIV-1 reactivation in infected individuals and might contribute to the systemic dissemination of the virus.
IRIS hypothesis:
immune reconstitution inflammatory syndrome
Gaitan Cepeda 2008
5/8/2018
J Immunol Mar 15;182(6):

22. چگونه می توان از بروز فراوان بیماری های پریودنتال در افراد مبتلا به ویروس HIV جلوگیری نمود؟
پیش از اقدام به درمان پریودنتال این افراد, چه ملاحظاتی را باید مدنظر داشت؟
5/8/2018