Department of Clinical Dentistry, University of Bergen, P. O Box 7800 5020, Bergen, Norway.
Bergen Addiction Research Group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
BMC Public Health. 2020 Mar 30;20(1):423. doi: 10.1186/s12889-020-08564-1.
Very few studies consider the oral health status and quality of life in HIV-1 exposed uninfected (HEU) children. The aim of this study was to estimate the prevalence of caries in primary teeth and its oral health related quality of life impacts in HEU children compared to HIV-unexposed-uninfected (HUU) children, whilst adjusting for confounding covariates.
This study uses data from the Ugandan site of the ANRS 121741 PROMISE- PEP trial (ClinicalTrials.gov, number NCT00640263) conducted in 2009-2013 that recruited mothers with HIV-1 and their uninfected children. Of 244 HEU-children-caretaker pairs available at the end of the one-year trial, 166 were re-enrolled in the ANRS 12341 PROMISE-PEP M&S study at 5-7 years and 164 were included in this study. These were age and sex-matched with 181 HUU children-caretaker comparators. Caries experience was recorded using World Health Organization's Decayed, Missed and Filled teeth (dmft/DMFT) indices. The Early Childhood Oral health Impact Scale (ECOHIS) was used for assessment of oral health related quality of life. Mixed effects logistic regression was conducted with dmft and ECOHIS scores as outcomes and HIV-1 exposure status as the main exposure.
Forty-eight percent of HEU children and 60% of HUU had dmft> 0. Corresponding figures for ECOHIS> 0 were 12% of HEU and 22% of HUU. The crude analysis showed differences related to HIV-1 exposure in caries experience and oral health related quality of life. Mixed effect logistic regression analyses were not significant when adjusted for use of dental care and toothache. If caregivers' DMFT> 0, the adjusted odds ratio for caries experience (dmft> 0) was 1.6 (95% CI: 1.0-2.8) while if dmft> 0 the adjusted odds ratio for quality of life impacts (ECOHIS> 0) was 4.6 (95% CI: 2.0-10.6).
The prevalence of untreated caries in primary teeth and quality of life impacts was high in this study population. HIV-1 exposed uninfected children were not more likely than HUU children to experience dental caries or have impaired oral health related quality of life. Given the global expansion of the HEU child population, the present findings indicating no adverse effect of pre- and post-natal HIV-1 exposure on caries in deciduous teeth are reassuring.
很少有研究关注 HIV-1 暴露未感染（HEU）儿童的口腔健康状况和生活质量。本研究旨在比较 HIV-1 未暴露未感染（HUU）儿童，估计 HEU 儿童乳牙龋齿的患病率及其对口腔健康相关生活质量的影响，并对混杂因素进行调整。
本研究使用了 2009-2013 年在乌干达进行的 ANRS 121741 PROMISE-PEP 试验（ClinicalTrials.gov，编号 NCT00640263）的数据，该试验招募了 HIV-1 阳性母亲及其未感染的儿童。在为期一年的试验结束时，共有 244 对 HEU-儿童-照顾者可供使用，其中 166 对在 5-7 岁时重新参加了 ANRS 12341 PROMISE-PEP M&S 研究，164 对纳入本研究。这些儿童与 181 名 HUU 儿童-照顾者匹配，按年龄和性别进行匹配。使用世界卫生组织的龋齿、失牙和补牙（dmft/DMFT）指数记录龋齿情况。使用幼儿口腔健康影响量表（ECOHIS）评估口腔健康相关生活质量。以 dmft 和 ECOHIS 评分作为结果，以 HIV-1 暴露状况作为主要暴露因素，进行混合效应逻辑回归分析。
48%的 HEU 儿童和 60%的 HUU 儿童的 dmft>0。ECOHIS>0 的相应数字分别为 12%的 HEU 和 22%的 HUU。初步分析显示，与 HIV-1 暴露相关的龋齿发生情况和口腔健康相关生活质量存在差异。调整了牙齿保健和牙痛的使用后，混合效应逻辑回归分析无统计学意义。如果照顾者的 DMFT>0，则龋齿发生情况（dmft>0）的调整优势比为 1.6（95%可信区间：1.0-2.8），而如果 dmft>0，则口腔健康相关生活质量影响（ECOHIS>0）的调整优势比为 4.6（95%可信区间：2.0-10.6）。
在本研究人群中，乳牙未治疗龋齿的患病率和生活质量影响均较高。与 HUU 儿童相比，HIV-1 暴露未感染儿童的龋齿或口腔健康相关生活质量受损的可能性并不更高。鉴于全球 HEU 儿童人口的增加，目前发现产前和产后 HIV-1 暴露对乳牙龋齿无不良影响令人欣慰。
