Oral Manifestations in HIV/AIDSInfected Children

ABSTRACT

Objectives: To assess factors influencing the distribution of oral manifestations in HIV/AIDS-infected children attending the Paediatric Infectious Disease Clinic in Mulago Hospital, Kampala. Methods: This was a cross-sectional study comprising 237 children (males/females: 113/124) aged 1 to 12 years. The parents/guardians were interviewed to obtain demographic information, oral hygiene practices, dietary habits and health seeking behaviours as well as any medications taken. The children were clinically examined for oral lesions based on World Health Organization criteria with modifications. Results: About 71.7% of the children cleaned their teeth. About 16.9% of the children had visited a dentist since birth, mainly for emergency care. One or more oral lesions were recorded in 73% of the children of whom 19.0% experienced discomfort during oral functions. Cervical lymphadenopathy, oral candidiasis and gingivitis were the most common soft tissue oral lesions: 60.8%, 28.3% and 19.0%, respectively. Except for dental caries, the overall frequency distribution of soft tissue oral lesions was significantly lower in children on highly active antiretroviral therapy (HAART) as compared to their counterparts not on HAART. The prevalence of dental caries in deciduous and permanent dentitions was 42.2% and 11.0%, respectively. Tooth brushing and previous visits to the dentist were indirectly and significantly associated with dental caries. About 5.9% (n=14) of the children had <200 CD3 + CD4 T-lymphocyte cells per μl of blood. Conclusions: The majority of the children had one or more oral lesions, particularly in the group not on HAART. Some of the lesions were associated with discomfort during oral functions. (Eur J Dent 2011;5:291-298)

Key words:

HIV/AIDS-infected children - Oral manifestations - Uganda

• REFERENCES

• 1 Kozinetz CA, Carter AB, Simon C, Hicks MJ, Rossmann SN, Flaitz CM, et al. Oral manifestations of pediatric vertical HIV infection. AIDS Patient Care STDs 2000;14:89-94.
• 2 Moniaci D, Greco D, Flecchia G, Raiteri R, Sinicco A. Epidemiology, clinical features and prognostic value of HIV-1 related oral lesions. J Oral Pathol Med 1990;19:477-481.
• 3 Ramos-Gomez F. Dental considerations for the paediatric AIDS/HIV patient. Oral Dis 2002;8:49-54.
• 4 Margiotta V, Campisi G, Mancuso S, Accurso V, Abbadessa V. HIV infection: oral lesions, CD4+ cell count and viral load in an Italian study population. J Oral Pathol Med 1999;28:173-177.
• 5 Ramírez-Amador V, Esquivel-Pedraza L, Sierra-Madero J, Soto-Ramirez L, González-Ramírez I, Anaya-Saavedra G, et al. Oral clinical markers and viral load in a prospective cohort of Mexican HIV-infected patients. AIDS 2001;15:1910- 1911.
• 6 Hodgson TA, Rachanis CC. Oral fungal and bacterial infections in HIV-infected individuals: an overview in Africa. Oral Dis 2002;8:80-87.
• 7 Ketchem L, Berkwitz RJ, Mcllveen L, Forrester D, Rakusan T. Oral findings in HIV-seropositive children. Peadiatr Dent 1990;12:143-146.
• 8 European Collaborative Study. Children born to women with HIV-1 infection: natural history and risk and transmission. Lancet 1991;337:253-260.
• 9 Costa LR, Villena RS, Sucasas PS, Birman EG. Oral findings in peadiatric AIDS: a case control study in Brazilian children. AIDS J Dent Child 1998;65:186-190.
• 10 Flaitz C, Wullbrandt B, Sexton J, Bourdon T, Hicks J. Prevalence of orofacial findings in HIV-infected Romanian children. Peadiatr Dent 2001;23:44-50.
• 11 Khongkunthian P, Grote M, Isaratanan W, Piyaworawong S, Reichart PA. Oral manifestations in 45 HIV-positive children from Northern Thailand. J Oral Pathol Med 2001;30:549- 552.
• 12 Naidoo S, Chikte U. Oro-facial manifestations in peadiatric HIV: a comparative study of institutionalized and hospital outpatients. Oral Dis 2004;10:13-18.
• 13 Schmidt-Westhausen AM, Priepke F, Bergmann F, Reichart PA. Decline in the rate of oral opportunistic infections following introduction of highly active antiretroviral therapy. J Oral Pathol Med 2000;29:336-341.
• 14 Bretz WA, Flaitz C, Moretti A, Corby P, Schneider LG, Nichols CM. Medication usage and dental caries outcome-related variables in HIV/AIDS patients. AIDS Patient Care STDs 2000;14:549-554.
• 15 Hodgson TA, Greenspan D, Greenspan JS. Oral lesions of HIV disease and HAART in industrialized countries. Adv Dent Res 2006;19:57-62.
• 16 Miziara ID, Weber R. Oral lesions as predictors of highly active antiretraoviral therapy failure in Brazilian HIV-infected children. J Oral Pathol Med 2008;37:99-106.
• 17 Mayanja B, Morgan D, Ross A, Whitworth J. The burden of mucocuteneous conditions and the association with HIV- 1 infection in a rural community in Uganda. Trop Med Int Health 1999;4:349-354.
• 18 Tirwomwe JF, Rwenyonyi CM, Muwazi LM, Besigye B, Mboli F. Oral manifestations of HIV/AIDS in clients attending TASO clinics in Uganda. Clin Oral Invest 2007;11:289-292.
• 19 Gelbier M, Lucas V, Zervous NE, Roberts GJ, Novelli V. A preliminary investigation of dental disease in children with HIV infection. Int J Peadiatr Dent 2000;10:13-18.
• 20 World Medical Association. Declaration of Helsinki, version VI, 2002. URL: http://www.wma.net/e/policy/b3.htm. Accessed November 4, 2009.
• 21 World Health Organization. Oral health surveys. Basic methods. 5th ed. Geneva, 1997.
• 22 Ramos-Gomez FJ, Flaitz CM, Catapano P, Murray P, Milnes AR, Dorenbaum A. Classification, diagnostic criteria, and treatment recommendations for orofacial manifestations in HIV-infected paediatric patients. J Clin Pediatr Dent 1999;23:85-96.
• 23 Mugrditchian L, Arent-Fine J, Dwyer J. The nutrition of the HIV-infected child: Part I: A Review of Clinical issues and Therapeutic Strategies. Top Clin Nutr 1992;7:1-10.
• 24 Winter HS, Miller TL. Gastrointestinal and nutritional problems in pediatric HIV disease. In: Pediatric AIDS, 2nd Ed. Pizzo PA, Wilfert CM, Eds. Philadelphia: Williams and Wilkins, 1994, pp. 513-533.
• 25 Enwonwu CO. Interface of malnutrition and human immunodeficiency virus infection in sub-Saharan Africa: a critical review. Nutr Res 1992;12: 1041-1050.
• 26 Hastreiter RJ, Jiang P. Do regular dental visits affect the oral health care provided to people with HIV? J Am Dent Assoc 2002;133:1343-1350.
• 27 Okunseri C, Badner V, Wiznia A, Rosenberg M. Dental visits by paediatric HIV-infected medical patients. NY State Dent J 2003;69:26-29.
• 28 Westaway MS, Viljoen E, Rudolph MJ. Utilisation of oral health services, oral health needs and oral health status in a peri-urban informal settlement. S Afr Dent J 1999;54:149- 152.
• 29 Jensen K, Kizito E K, Langbæk J, Nyika T A. Dental caries, gingivitis and oral hygiene among schoolchildren in Kampala, Uganda. Community Dent Oral Epidemiol 1973;1:74-83.
• 30 Rwenyonyi CM, Birkeland JM, Haugejorden O, Bjorvatn K. Dental caries among 10 – 14-year-old children in Ugandan rural areas with 0,5 and 2.5 mg fluoride per liter in drinking water. Clin Oral Invest 2001;5:45-50.
• 31 Muwazi LM, Rwenyonyi CM, Tirwomwe FJ, Ssali C, Kasangaki A, Nkamba ME, et al. Prevalence of oral diseases/conditions in Uganda. Afr Health Sci 2005;5:227-233.
• 32 Matti R, Kalevi S, Ilkka P. Relationship between reported toothbrushing and dental caries in adults. Community Dent Oral Epidemiol 1980;8:128-131.
• 33 Howell BR, Jandinski JJ, Palumbo P, Shey Z, Houpt MI. Oral soft tissue manifestations and CD4 lymphocyte counts in HIV-infected children. Pediatr Dent 1996;18:117-120.
• 34 Gaitán-Cepeda L, Cashat-Cruz M, Morales-Aguirre JJ, Sanchez-Vargas L, Aquino-Garcia S, Fragoso-Rios R, et al. Prevalence of oral lesions in Mexican children with perinatally acquired HIV: association with immunologic status, viral load, and gender. AIDS Patient Care STDs 2002;16:151- 156.