The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth

ObjectiveTo compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU).MethodsIn a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models.ResultsEleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment.ConclusionsOral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions.

研究目的：对比围产期HIV感染（perinatally HIV-infected, PHIV）青少年与围产期暴露于HIV但未感染（perinatally HIV-exposed but uninfected, PHEU）青少年的口腔健康参数。
研究方法：本研究依托儿童艾滋病队列研究开展横断面子研究，对受试者的龋牙数（decayed teeth, DT）、龋失补指数（Decayed, Missing, and Filled Teeth, DMFT）、口腔黏膜疾病及牙周疾病（periodontal disease, PD）进行检查。采用零膨胀负二项回归与有序逻辑回归模型分析口腔健康参数的协变量。
研究结果：11个研究中心共招募209名PHIV青少年与126名PHEU青少年。PHIV受试者、女性受试者、无常规口腔医疗来源的受试者、每日进食/零食次数≥5次（相较于0~3次）者以及每日饮用果汁/碳酸饮料≥5次（相较于0~3次）者的DT评分更高，其校正均数比（Adjusted Mean Ratio, aMR）分别为1.7（95%置信区间：1.2~2.5）、1.4（95%置信区间：1.0~1.9）、2.3（95%置信区间：1.5~3.4）、1.9（95%置信区间：1.1~3.1）与1.6（95%置信区间：1.1~2.4）。年龄≥19岁者、以亲生父母为照料者者、每日饮用果汁/碳酸饮料≥5次者以及唾液流率较低者的DMFT评分更高，其aMR分别为1.9（95%置信区间：1.2~2.9）、1.2（95%置信区间：1.0~1.3）、1.4（95%置信区间：1.1~1.7）与0.8（每单位升高，95%置信区间：0.6~1.0）。80%的受试者存在PD；基于患者健康分类（牙龈炎或轻度、中度、重度牙周炎）分析，不同HIV感染状态的受试者间未观察到差异。校正后，CD4细胞计数与病毒载量与口腔健康结局无关联。
研究结论：PHIV与PHEU青少年的口腔健康状况不佳。鉴于美国多数HIV感染儿童均在医疗诊所接受密切随访，这一结果令人担忧。本研究数据凸显了常规口腔护理的必要性。由于PHIV青少年患龋风险更高，因此深入阐明二者间的关联以制定针对性干预措施具有重要意义。