It is well-established that dental caries (dental decay), one the most prevalent diseases in the United States, tends to disproportionably affect racial and ethnic minorities, and those who are economically and socially disadvantaged, and those with underlying medical problems. HIV+ persons are likely to be ethnic/racial minorities and are likely to be socio-economically disadvantaged, compared to HIV- persons. A recent 5-year investigation found that HIV infection was related to dental caries, but reasons for the disparity were unclear, and, perhaps most importantly, risk factors for caries within the HIV+ persons were not well defined as a result of this study. The objective of this proposed investigation is to clarify the relationship between HIV infection and dental caries. The Women's Interagency HIV Study (WIHS) and its oral sub-study (WIHS-OS) represent one of the largest studied cohorts of HIV+ persons in the United States, and provide the largest collection medical, interview and dental data of HIV+ persons followed for an extended period of time, beginning in 1995 and ending only recently (November, 2004). As part of the WIHS-OS, 844, primarily minority, women (719 HIV+, 125 HIV-) were recruited from the parent WIHS core in 1995-96; in 2001/02, in order to investigate the effects of HIV medications on a variety of outcomes, an additional 173 HIV+ women were added, for a total of 1017 women. Participants had interviews, medical and dental exams every six months. We propose to examine, using standard and appropriate statistical methodologies, using the WIHS and the WIHS-OS, whether demographic factors (income, education, race/ethnicity, drug use), behavioral factors (smoking, illicit drug use, use of dental services and oral self-care), HIV disease severity, HIV medication use, and oral health factors (saliva, oral hygiene and gum disease) are related to the development of caries over ten years. These proposed analyses are different from analyses that have been previously done because they will include data collected over the entire 10-year period of observation, from all women in the WIHS-OS and because they will include analysis of factors that have not previously been examined in this group. These analyses provide the best opportunity to resolve currently unanswered questions regarding the nature of caries in HIV+ persons, given the size of the database, the long, prospective nature of the follow-up for dental caries, and the high quality of the data. The results of these analyses will provide greatly needed clinical, practical, and public health information to dental and medical providers, as well as to those persons and agencies that are indebted to caring for the medical, dental and social welfare of persons with HIV infection. Recent studies have found that HIV infection may predispose persons to the development of dental decay (caries) due to side effects from medications and because of health damaging and health promoting behaviors in HIV+ persons. This proposed study is relevant because will resolve currently unanswered questions regarding the nature of caries in HIV+ persons. The results of these analyses will provide greatly needed clinical, practical, and public health information to dental and medical providers, as well as to those persons and agencies that are indebted to caring for the medical, dental and social welfare of persons with HIV infection. ? ? ?
