Patients living with HIV (PLWH) are living longer as a result of treatment with antiretroviral therapy (ART), either single agent or combined therapy (cART). Though the general outcomes of suppressing HIV is a plus, the prevalence of oral and systemic health problems in this population cannot be overemphasized nor ignored. The goal of this research is to address gaps in our knowledge of the oral health status of patients living with HIV (PLWH) who also have non communicable diseases (NCDs) in order to explore the combined effects of HIV, ART, and aging-related NCDs on the extent and progression of oral/dental conditions (e.g. caries, periodontal diseases, salivary gland dysfunction, and oral cavity coinfections). We will be employing an interdisciplinary approach to leverage expertise from both dental and medical professionals, representing a valuable opportunity to bridge the gap between oral-systemic diseases amongst PLWH. Our preliminary data showed a high caries and periodontal disease prevalence among PLWH on ART (both > 80%), as well as findings of ?metabolic complications? such as cardiovascular disease (48.5%), hyperlipidemia (33.2%) and diabetes (14.9%) in this population, which makes our population an ideal cohort for a prospective and well-designed study. The central hypothesis is that the extent and progression of key oral diseases (e.g. caries, periodontal diseases and oral cavity coinfections), is associated with ART induced salivary changes (e.g. xerostomia, change in saliva composition); and are exacerbated in PLWH (>1 year ART) with NCDs, compared to PLWH without NCDs. We will also prospectively investigate the range of metabolic abnormalities observed in PLWH on ART and explore the hypothesis that poor oral health and salivary dysfunction, concurrent with these metabolic abnormalities, play a critical role in both supporting and driving chronic immune activation and inflammation in HIV infection. By 2020, it is expected that >30 million people living with HIV will have access to ART. Progress towards improving outcomes for these individuals will depend on the identification of novel strategies for the prevention and treatment of these non-AIDS- associated comorbidities. This is important in order to better understand if infection with HIV or the exposure and extended use of ART affects the prevalence and severity of these oral diseases. In addition, there is an unmet need to investigate strategies to control host-immune cART response associated with oral and systemic co-infections, and comorbidities or mediators among PLWH. These efforts could help to generate evidence for oral health treatment guidelines tailored to the needs of dental patients with HIV.
This proposal represents an interdisciplinary and collaborative effort between dental and medical experts, towards improving outcomes for PLWH by proposing a prospective study for the identification of oral-systemic non-AIDS- associated comorbid diseases (NCDs) in a large population of HIV individuals, who have been on ART for at least one year. Results from our study will lead to a better understanding of key oral health manifestations among PLWH and their impact on the development and severity of NCDs. In addition, better understanding the interplay of oral and systemic inflammation in PLWH on long-term ART has the potential to improve oral and systemic outcomes and inform clinicians on novel interdisciplinary approaches (e.g. oral- systemic-connection) of reducing inflammation among PLWH.
