Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Melen Road, PO Box 3077, Yaoundé, Cameroon.
Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon.
BMC Oral Health. 2020 Dec 11;20(1):359. doi: 10.1186/s12903-020-01353-7.
HIV infection is associated to different oral manifestations (including periodontal diseases), which have decreased with the advent of antiretroviral therapy (ART). Yet, the occurrence of periodontitis is still consistent among patients with HIV living in sub Saharan-Africa, with limited evidence on the driven factors and mitigating measures in these settings. We aimed at evaluating the occurrence of periodontitis and its associated immunological and virological factors in patients with HIV living in Yaoundé, Cameroon.
We included 165 (44 ART-naïve and 121 ART-experienced) patients > 18 years old attending the Yaoundé Central Hospital and the Chantal BIYA International Reference Centre, from January-April 2018. The periodontal status was assessed by measuring the clinical attachment loss, periodontal pocket depth, plaques index and gingival bleeding index. CD4+/CD8+ cells and viremia were measured using the fluorescence-activated cell sorting method (FACS Calibur) and the Abbott m2000 RT HIV-1 RNA kit respectively. A standard-questionnaire concerning participants' medical records and oral hygiene methods was filled. Data was analyzed and p < 0.05 considered statistically significant.
There was a significantly high prevalence of periodontitis in the ART-naïve (53.2%) compared to the ART-experienced group (37.3%), with a twofold increased risk of the ART-naïve population presenting with periodontitis than the ART-experienced population (OR 2.06, p = 0.03). More importantly, ART-naïve, patients with CD4 < 200 cells presented with higher risk of having periodontitis compared to those with higher CD4-values, with a threefold difference (OR 3.21). Worth noting, males presented with a higher risk of having clinical attachment loss (OR 6.07). There was no significant association between the occurrence of periodontitis and the CD8 (p = 0.45) or viremia (p = 0.10).
In the Cameroonian context, a considerable number of adults infected with HIV suffer from periodontitis regardless of their treatment profile. Nonetheless, ART-naïve patients have a higher risk, indicating the protective role of ART. Interestingly, severely immune-compromised patients and men are vulnerable to periodontitis, thereby highlighting the need for clinicians to refer patients for regular periodontal screening especially male patients and those with low CD4. Such measures could greatly improve the quality of life of the population living with HIV in Cameroon.
HIV 感染与不同的口腔表现（包括牙周疾病）有关，随着抗逆转录病毒疗法（ART）的出现，这些疾病有所减少。然而，在撒哈拉以南非洲的 HIV 感染者中，牙周炎的发生仍然很常见，关于这些环境下的驱动因素和缓解措施的证据有限。我们旨在评估喀麦隆雅温得的 HIV 感染者中牙周炎的发生及其相关的免疫和病毒学因素。
我们纳入了 165 名（44 名未接受 ART 治疗和 121 名接受 ART 治疗）年龄大于 18 岁的患者，他们于 2018 年 1 月至 4 月期间在雅温得中央医院和尚塔尔·比亚国际参考中心就诊。通过测量临床附着丧失、牙周袋深度、菌斑指数和牙龈出血指数来评估牙周状况。使用荧光激活细胞分选法（FACS Calibur）和 Abbott m2000 RT HIV-1 RNA 试剂盒分别测量 CD4+/CD8+细胞和病毒载量。填写了一份关于参与者病历和口腔卫生方法的标准问卷。对数据进行了分析，p<0.05 被认为具有统计学意义。
未接受 ART 治疗的患者（53.2%）与接受 ART 治疗的患者（37.3%）相比，牙周炎的患病率显著较高，未接受 ART 治疗的患者发生牙周炎的风险是接受 ART 治疗的患者的两倍（OR 2.06，p=0.03）。更重要的是，与 CD4 值较高的患者相比，CD4<200 个细胞的未接受 ART 治疗的患者发生牙周炎的风险更高，差异有三倍（OR 3.21）。值得注意的是，男性发生临床附着丧失的风险更高（OR 6.07）。牙周炎的发生与 CD8（p=0.45）或病毒载量（p=0.10）之间没有显著关联。
在喀麦隆的情况下，相当数量的感染 HIV 的成年人患有牙周炎，无论其治疗情况如何。然而，未接受 ART 治疗的患者风险更高，表明 ART 具有保护作用。有趣的是，严重免疫受损的患者和男性易患牙周炎，这突显出临床医生需要为定期牙周筛查转介患者，特别是男性患者和 CD4 较低的患者。这些措施可以大大提高喀麦隆 HIV 感染者的生活质量。
