USC University of Southern California

HIV/AIDS’ Toll on Oral Health

In the 27 years since the beginning of the HIV/AIDS epidemic in the United States, that which was once an unavoidable death sentence has largely become a chronic condition when properly managed with medication.

However, both the manifestation of the virus as AIDS as well as the retroviral therapy used to keep HIV in check can take a heavy toll on a patient, including one’s oral health and quality of life. Two recently published USC School of Dentistry studies examine data from the Women’s Interagency HIV Study (WIHS), a cohort made up of hundreds of HIV-positive and at-risk women at six sites throughout the country, to discern how the disease and its management affects women.

While AIDS itself can increase the chance of mouth lesions, infections, dry mouth and other oral maladies, a common treatment method can itself have negative oral side effects, according to data collected from the cohort. Protease inhibitor-based highly active antiretroviral therapy (HAART), a treatment used to suppress HIV replication and preserve patient immunity, is a significant risk factor for decreased salivary gland function, according to the study “Effect of HAART on salivary gland function in the Women’s Interagency HIV Study.” The study, led by School of Dentistry Diagnostic Sciences Division Chair Mahvash Navazesh, was published on Nov 11, 2008 in Oral Diseases.

The impact of low salivary flow is much more than just the discomfort of a dry mouth, Navazesh said. With less saliva to wash away cariogenic food and moisten soft tissues, dry mouth can accelerate tooth decay and make irritated tissue more susceptible to infection.

“Saliva plays an important role in maintaining the health of the oral cavity,” she said.

Previously, Navazesh and her team reported that HIV infection is a risk factor for low saliva flow rate. The current study demonstrated that the management of the disease with HAART is yet another risk factor for low saliva flow, she said.

In “Oral health-related quality of life among HIV-infected and at-risk women,” principal investigator and School of Dentistry Associate Dean of Community Health Programs Roseann Mulligan and her team evaluate not just the oral health of hundreds of WIHS cohort participants, but also examine the psychosocial and emotional impact of the disease’s effects on oral health.

“Women participating in this study are minorities, poor, less educated and either HIV-infected or at risk of infection; they are vulnerable women in our society,” said Hazem Seirawan, the study’s second author and research assistant professor with the School of Dentistry.

Participants were evaluated physically and asked questions on several subjects including functional limitation, discomfort and pain as well as psychological and social discomfort and disability related to their oral health. On average, HIV-infected women had 10 percent lower oral health-related quality of life compared to non-infected women, Mulligan said. However, after adjusting for significant clinical and behavioral oral health factors, including drug use, the difference in quality of life was much less prominent.

“The study identifies many specific factors where dental professionals can intervene and help both HIV-positive and at-risk patients have better oral health-related quality of life,” Mulligan said.

Simply having access to more follow-up care can help greatly, Seirawan added.

“It seems that follow-up visits, when women came for their semiannual check-up, were significant in reducing the difference in oral health-related quality of life between the two groups of women,” he said.

The study appeared in Community Dentistry and Oral Epidemiology on Sept 8, 2008.