Yengopal V, Kolisa Y, Thekiso M D, Molete M P
Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Oral Dis. 2016 Apr;22 Suppl 1:25-34. doi: 10.1111/odi.12411. Epub 2016 Feb 16.
Although sub-Saharan Africa caries the burden of paediatric and adult HIV/AIDS infections, the epidemic is spreading most rapidly in the Middle East and North Africa Region where between 2005 and 2013, AIDS-related deaths increased by 66% in comparison with a worldwide fall of 35%. For the first time, in 2011, more than half of people in need of antiretroviral drugs were receiving them, with coverage reaching 54%; yet only 28% of children have access to HIV treatment. This review sought to provide an update of paediatric and adolescent oral HIV/AIDS issues in resource poor countries.
To review the literature on paediatric & adolescent HIV with a focus on oral lesions as predictors of HIV infection; as markers of the efficacy of HAART and quality of life; caries risk; management of oral lesions; and epidemiological tests for clinical significance of oral lesions.
A search strategy was developed for PubMed to identify papers on paediatric oral HIV. Publications in English were selected on the basis that their titles and abstracts were relevant to the review objectives. The reference lists of included papers were screened for additional articles. The time-search for publications was limited from 2009 to 15 October 2014.
Papers on the prevalence of oral lesions lacked standardization in diagnostic criteria and the introduction of HAART had significantly reduced prevalence; oral lesions remain useful predictors for HIV infection and as markers for the efficacy of HAART. Evidence suggest that caries risk is increased with HIV infection; management of oral lesions is inconsistent with available resources and surprisingly little recent information has been published in the past 5 years. Revised case definitions are proposed for large-scale epidemiologic studies with the development of an oral lesion index showing promise. Oral health quality of life indicators for children and adolescents are becoming important as more of these indicators are being developed and their negative oral impacts in individuals with oral lesions are now well established.
Paediatric and adolescent oral HIV research needs to be prioritized as current studies are few and are characterized by poor quality study designs, small study samples and a lack of multicentre collaborations. There is a lack of high quality evidence for a number of interventions available for management of oral lesions.
尽管撒哈拉以南非洲地区承担着儿童和成人艾滋病毒/艾滋病感染的负担，但该流行病在中东和北非地区传播最为迅速，2005年至2013年期间，与艾滋病相关的死亡人数增加了66%，而全球范围内则下降了35%。2011年，需要抗逆转录病毒药物的人群中，超过一半的人首次获得了此类药物，覆盖率达到54%；然而，只有28%的儿童能够获得艾滋病毒治疗。本综述旨在更新资源匮乏国家儿童和青少年口腔艾滋病毒/艾滋病问题。
回顾有关儿童和青少年艾滋病毒的文献，重点关注口腔病变作为艾滋病毒感染的预测指标；作为高效抗逆转录病毒治疗（HAART）疗效和生活质量的标志物；龋齿风险；口腔病变的管理；以及口腔病变临床意义的流行病学检测。
制定了一项针对PubMed的检索策略，以识别有关儿童口腔艾滋病毒的论文。根据论文标题和摘要与综述目标相关的标准，选择英文出版物。对纳入论文的参考文献列表进行筛选，以查找其他文章。出版物的时间检索范围限制在2009年至2014年10月15日。
关于口腔病变患病率的论文在诊断标准上缺乏标准化，HAART的引入显著降低了患病率；口腔病变仍然是艾滋病毒感染的有用预测指标以及HAART疗效的标志物。有证据表明，艾滋病毒感染会增加龋齿风险；口腔病变的管理与可用资源不一致，令人惊讶的是，在过去5年中几乎没有发表最新信息。随着显示出前景的口腔病变指数的开发，为大规模流行病学研究提出了修订后的病例定义。随着越来越多的儿童和青少年口腔健康生活质量指标被开发出来，并且它们对有口腔病变个体的负面口腔影响现在已得到充分证实，这些指标正变得越来越重要。
儿童和青少年口腔艾滋病毒研究需要被优先考虑，因为目前的研究很少，且具有研究设计质量差、研究样本小和缺乏多中心合作的特点。对于许多可用于管理口腔病变的干预措施，缺乏高质量证据。
