Int J Virol AIDS ISSN: 2469-567X

• Commentary
• Table 1
• Table 2
• References

Download PDF
    

International Journal of Virology and AIDS

¹Tissue Engineering and Regenerative Medicine Laboratory, University of Monterrey, Mexico
²Department of Orthodontics, Pediatric Dentistry and Special Care, School of Dentistry, University of Louisville, USA

Commentary

The existence of one or more oral lesions is among the first manifestations in children with acquired immunodeficiency syndrome (AIDS). Moreover, oral candidiasis and oral hairy leukoplakia are predictors of AIDS evolution and are related with CD4+ T-lymphocyte cell count <200 cells/ l [1].

The prevalence of oral lesions in human immunodeficiency virus (HIV)-infected children in developed countries is equivalent to 72%, meanwhile in developing countries it equates to 60%. For this reason health professionals should identify and treat the numerous oral manifestations in HIV-infected children. There are several oral lesions that could be present in HIV-infected children [2] (Table 1). However, the prevalence of oral lesions is considerably lower in children on highly active antiretroviral treatment (HAART) as compared to their equivalents not on HAART [3].

In regards to caries problems in children with HIV, the problem increases as the CD4 counts decreases; however, in HIV-infected children taking HAART, the rate of decay is less associated with patients not receiving HAART [4]. Furthermore, clinicians must know the side effects on their oral health of drug taken; the CD3+ + CD4+ T-lymphocyte amount and proportion; and to solicit supplementary laboratory examinations including hepatitis, herpes, varicella zoster and papillomavirus with the purpose to offer secure management for HIV-infected children [5].

In general dental practice, children with AIDS disease in stage 2, to stage 3 or 4 (Table 1) according to the American Academy of Pediatrics Dentistry and World Health Organization classification (CD4 amounts), patients with absolute neutrophil count below 1,500/mm³ and/or with deranged liver functions tests will need antibiotic prophylaxis. Another important aspect is that patients with low platelet quantities (10,000-30,000/μL) require a platelet transfusion prior to surgical procedures [5].

Oral problems have an undesirable influence on the nutritional health status of HIV-infected children by decreasing food intake as a consequence of pain during ingestion as these patients have one or more oral manifestations. Malnutrition predisposes to periodontal disease, candidiasis and xerostomia.

To provide safe care for HIV-infected children, clinicians must know essential recommendations for treatment planning and prevention (Table 2). Managing for these HIV-infected children requires close synchronization between the dentist, the pediatrician, the nutritionist and the childīs parents or tutors. Preserving satisfactory oral health through prevention associated with suitable treatment makes it feasible to maintain general health in these children.

References

1. Margiotta V, Campisi G, Mancuso S, Accurso V, Abbadessa V (1999) HIV infection: oral lesions, CD4+ cell count and viral load in an Italian study population. J Oral Pathol Med 28: 173-177.
   


2. Rwenyonyi CM, Kutesa A, Muwazi L, Okullo I, Kasangaki A, et al. (2011) Oral Manifestations in HIV/AIDS-Infected Children. Eur J Dent 5: 291-298.
   


3. Manikandan S, Suresh Kumar V, Ramesh K (2013) Oral manifestations of HIV infected children undergoing highly active antiretroviral therapy. J Pierre Fauchard Acad; 27: 49-52.
   


4. Hicks MJ, Flaitz CM, Carter AB, Cron SG, Rossmann SN (2000) Dental caries in HIV-infected children: a longitudinal study. Pediatr Dent; 22: 359-364.
   


5. Fine DH, Tofsky N, Nelson EM, Schoen D, Barasch A (2003) Clinical implications of the oral manifestations of HIV infection in children. Dent Clin North Am 47: 159-174, xi-xii.