The proposed study will determine the prevalence and natural history of dental caries, oral mucosal and gingival lesions, and oral opportunistic diseases in infants and children with vertical HIV infection, and compare the rate of occurrence of oral manifestations in HIV-infected infants followed longitudinally with that observed in a control population of HIV-exposed but uninfected infants. The relationship between immunologic and virologic markers of HIV disease status and the prevalence and evolution of oral manifestations will be explored. Changes in the oral microbial flora (bacteria, fungi and viruses) which occur with aging and HIV disease progression will be explored and correlated with the occurrence of oral manifestations of disease. A comprehensive assessment of the etiologic nature of oral clinical pathologic lesions will be performed. Specifically, during years 1 and 2 HIV-infected infants and children will be enrolled into two study groups. Group 1 will consist of symptomatic HIV-infected subjects less than 36 months of age; group 2 will be composed of young infants with vertical HIV exposure. Infants who are confirmed HIV-infected (using sophisticated virologic techniques) will be enrolled as soon as possible after six months of age into group 2. A control group will consist of age-matched HIV-exposed infants who have tested negative for the infection. All subjects (groups 1 and 2) will undergo every six months comprehensive oral examinations and cultures, HIV disease assessments and immunologic and virologic monitoring. Intercurrent illnesses will be evaluated comprehensively. All subjects will be followed in this manner through study year 5. This study will elucidate the rate of occurrence and natural history of common and often debilitating oral manifestations of HIV infection in infants and children. In addition, it will help define the significance of oral manifestations as markers for HIV disease status. Finally, examination of changes in the oral microbial flora will help to define the pathogenesis of gingival and periodontal disease, and may have important implications with respect to HIV disease progression.
