While living with the HIV virus is certainly not easy, researchers are trying to gain a better understanding of the oral infections that affect many HIV-positive patients to help improve their lives. HIV-positive patients, even those with proper dental health care practices, are susceptible to tooth decay and gum diseases in addition to infections caused by yeast, bacteria, and viruses like the human papillomavirus.
Oral Health in HIV-Positive Patients
According to Dr. Jose A. Vazquez, Chief of the Section of Infectious Diseases at the Medical College of Georgia at Georgia Regents University, “If we can improve the oral health of these patients, we believe it will further improve their overall health.”
Dr. Vazquez along with Dr. Scott S. De Rossi, Chairman of the Department of Oral Health and Diagnostic Sciences at the GRU College of Dental Medicine, are part of a new study funded by the National Institutes of Health to discover if the chronic dental health problems of HIV-positive patients are caused by the HIV infection, antiretroviral therapy, or a combination of both. Together with researchers from Ohio State University as well as Louisiana State University they are collecting 440 samples from the mouths of HIV-positive patients to perform molecular tests and compare the results with samples from uninfected participants.
The molecular tests performed on the samples are quite sophisticated and are done to give researchers a census of the living organisms in the mouth and a T-cell count to determine the level of immune system activity. The researchers also hope to discover whether antiretroviral therapy affects the community of organisms, or microbiota, in the mouth by testing samples before and after therapy and comparing samples of those with oral complications to those without. The ultimate goal is to discover why HIV-positive patients are more susceptible to tooth decay and gum disease which Vazquez and De Rossi believe is because these patients have different sets of oral bacteria in their mouths than those that are uninfected.
As these tests are performed, Vazquez’s lab will also be conducting further tests on samples containing oral complications such as yeast or the human papillomavirus. The presence of a yeast infection in the mouth is an early sign of HIV and it can quickly obstruct the esophagus making it difficult to swallow if not treated. The researchers will analyze samples of the yeast recovered from the patients to test if the strains are more aggressive or resistant to treatment in HIV patients. Yeast infections of the mouth can typically be treated with antifungal medications but missing a few doses can cause the yeast to develop a protective film that makes it resistant to treatment.
HPV in HIV Patients
According to De Rossi, human papillomavirus, or HPV, did not become a problem in HIV patients until the use of highly-active antiretroviral therapy for treatment. HPV spreads quickly in the mouth and can move to the rest of the body if patients inadvertently bite the infected area. Treatment for HPV normally yields marginal results and the virus often returns and may cause head and neck cancer in some patients.
“We don’t know a lot about the evolution of HPV in the mouth of anybody,” says Vazquez. “We have to characterize this HPV infection and how it advances in HIV patients from a state of colonization to a tiny lesion, to a little wart, to maybe head and neck cancer that requires major surgery.”
Antiretroviral therapies have been used for HIV-positive patients for the past decade and they have been instrumental in improving patient survival by stopping HIV from replicating in the cells so that T-cell levels can normalize. However, the researchers believe that the microbiota composition in the mouths of patients receiving these treatments does not restore to its natural composition, making them more susceptible to tooth decay, gum disease, and other oral health problems.