Assessment of oral health status and Treatment needs of HIV/AIDS patients visiting Government Hospitals and Rehabilitation centers in Banglore city.

Sir,

Acquired immune deficiency syndrome (AIDS) associated with HIV infection is undoubtedly the most rapidly advancing epidemic in recent times.

It is generally agreed that the recognition of some oral manifestations of HIV is of great importance, as these are among the earliest clinical manifestations and have been shown to be highly predictive markers of severe immunosuppression and disease progression.[1]

In spite of high prevalence, there are very few reports of oral lesions in Indian HIV/AIDS patients. The literature also lacks information about most common oral diseases like dental caries and periodontal disease in these patients. Thus, this study was undertaken to assess the oral health status and treatment requirements of HIV/AIDS patients in Bangalore city of India. Convenient sampling method was followed and a total of 172 patients were examined. The clinical oral examination was carried out under natural light with mouth mirror, CPITN probe, and was recorded in “WHO oral health assessment form 1986.”

The study group consisted of 172 individuals, of which 120 (69.8%) were males and 52 (30.2%) were females. The age of the patients ranged from 15 to 60 years; 94 patients (54.7%) were asymptomatic and 78 (45.3%) had AIDS. Among these patients, only 6 (3.5%) were under anti-retroviral therapy.

Dental caries experience in our study population was found to be 69.8%. The mean DMFT (decayed missing filled tooth) score was 2.96. As far as treatment need for the dental diseases using dentition status is concerned, 125 (72.7%) needed one or the other form of treatment.

Among these patients, 118 (68.8%) had oral soft tissue manifestation of HIV disease. Most commonly observed soft tissue lesion was gingivitis (30.8%) and periodontitis (29%). Candidiasis was the predominant soft tissue lesion among 44 (25.6%) patients, of which 2 (1.2%) had atrophic candidiasis and 26 (15.1%) had pseudomembranous candidiasis. Also, 16 (9.3%) patients had angular cheilites. Other forms of oral manifestations are depicted in the Figure 1. In our study, we have reported a patient with severe reaction to nevirapine.

Figure 1

Distribution of patients according to oral soft tissue manifestations due to HIV/AIDS

Prevalence of oral soft tissue lesion varies greatly in the literature, as it depends upon many factors like sample randomization, racial factor, socioeconomic status, examiner's clinical experience, and the use of different criteria for diagnosis. In this study, the prevalence of oral soft tissue lesions (68.6%) is less than that in previous Indian study (72%)[2] and more than that in a Taiwanese study (58%).[3]

Most common oral manifestation in our study is periodontium related such as that in previous Indian study,[2] but, in a German study,[4] candidiasis is the most common oral soft tissue manifestation. Oral hairy leukoplakia was most commonly reported finding in Taiwan study.[3] In our study, pseudomembranous candidiasis is the most common variety similar to the result obtained in a previous Indian study.[2] Prevalence of oral hairy leukoplakia in our study (2.3%) is almost similar to that in a previous Indian study.[2]

In the present study, a variety of oral soft tissue manifestations were reported. Further studies should be undertaken in various states of India, specifically now, in the era of anti-retroviral therapy to find out the changing prevalence of the oral lesions.