Since the advent of antiretroviral therapy (ART), the life expectancy of persons living with HIV (PLWH) has steadily increased in the United States. PLWH are now more likely to develop co-morbid age-related non- communicable diseases (NCDs) than are similarly-aged HIV-uninfected persons, and the morbidity and mortality of NCD and age-related conditions is paramount. The age-adjusted rates of multiple NCDs are higher among PLWH than among persons who are HIV negative. In addition, PLWH experience higher prevalence and severity of oral diseases, particularly related to the periodontium, although the factors that explain these disparities remain unclear. For example, is HIV-related immune suppression or viremia primarily responsible for these differences? Are lifestyle factors and access to dental care important determinants? Is the microbiome signature in PLWH unique and does it change over time? Since 1988, the AIDS Linked to the Intravenous Experience (ALIVE) study has successfully followed a lower-income, predominantly African American population of HIV-infected and at-risk persons with a history of injecting drugs (PWID) in a community-based cohort in Baltimore. Over three decades, ALIVE has characterized risk factors of incident HIV and progression to AIDS or death, described patterns of risk behaviors, identified barriers to optimal HIV care, and provided important insights into the natural and treated course of HIV among PWID. In recent years, ALIVE has transitioned to exploring the impact of aging with HIV, focusing on phenotypes and organ-specific non-communicable diseases (NCD) (e.g., liver, lung, cardiovascular, bone, kidney, neurocognitive and metabolic NCDs). The proposed project leverages the ALIVE platform to focus on the combined effects of HIV and NCDs on oral health at the health care-seeking, clinical, and microbiological levels.
The specific aims of the proposed project are to: 1) determine to what extent HIV status influences access to and utilization of oral health care services; 2) determine to what extent HIV status affects self-reported and clinical oral health status; 3) determine to what extent HIV status influences the progression of periodontitis; and 4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature. The first three specific aims include sub-aims that define the extent to which comorbid NCDs act as effect modifiers.
For specific aim 4, one sub-aim describes the extent to which HIV influences the oral microbiome and a second sub-aim defines how longitudinal changes in the oral microbiome signature affect periodontitis progression. To achieve these aims, we build upon biannual ALIVE study visits with interview, clinical examination, and biospecimen components, supplemented by medical record review and registry linkages. The key impact of these aims is to illuminate social and individual-level mechanisms, identify modifiable risk factors, and produce novel insights to inform efficient and targeted oral health interventions for PLWH in Baltimore and nationally.
People living with HIV are more likely to experience chronic conditions like diabetes and heart disease and are more likely to develop oral diseases than people who are HIV negative. There are many possible explanations for these disparities, including lifestyle choices and the way the body responds to HIV infection and treatments. This study will identify which explanations are most relevant so that oral health-related illness and disability for people living with HIV can be reduced in the future.
