HIV Stage and the Periodontal Status of HIV+ Patients
HIV Stage and the Periodontal Status of HIV+ Patients
Table 1 shows the descriptive statistics of age, CD4 + T cell counts and periodontal indices of the 120 HIV-positive patients included in the study. The mean age was 33.25 years with a median age of 32 years (range: 20–55). The mean values for plaque index, gingival index, probing depth and clinical attachment loss were 2.55, 2.75, 4.77 mm and 5.29 mm respectively.
The mean CD4 + T cell count was 293.43 cells/mm (Table 1). When grouped according to their CD4 + T cell counts into groups with <200 cells/mm (Group A), 200–500 cells/mm (Group B) and >500 cells/mm (Group C), 30% of the patients were assigned to Group A, indicating severe immunosuppression (Table 1), 59.17% to Group B, a moderate degree of immunosuppression, with Group C (11%) indicating a wide range of immune competence (510–859 cells/mm, Table 1). Figure 1 shows the breakdown of CD4 + T cell counts into intervals of 100, plotted against the CD4+ midpoint.
(Enlarge Image)
Figure 1.
Frequency distribution of CD4 + T cell counts grouped into intervals of 100 and plotted against the midpoint.
Although, plaque and gingival indices showed positive (0.01514) and negative (−0.01133) correlations with CD4 + T cell counts, no significant associations were reflected in the p values, (Table 2). However, significant correlations were indicated between clinical indices (PD, CAL) and the total CD4+ count (A + B + C). Figure 2 demonstrates the positive Spearman's correlation between clinical attachment level and CD4 + T cell counts. The lack of a correlation between individual groups A, B and C, with any of the clinical indices (Table 2), shows that the prevalence of periodontal disease in HIV-positive patients may not directly be related to the different stages of immunosuppression even though total CD4+ counts could be associated with changes observed in the periodontal measurements.
(Enlarge Image)
Figure 2.
Correlation of CD4 + T cell counts with clinical attachment level.
With an age range of 20–55 years (Table 1), we used Spearman rank correlation to examine whether age influenced the measurement of periodontal indices. Age was related to the clinical indices regardless of the patients' CD4 + T cell counts or their stages of immunosuppression. A highly significant positive correlation was found between age and plaque index (p = 0.0018) with a significant correlation with gingival index and probing depth (Table 3). However the level of clinical attachment showed no significant correlation with age.
Significant associations were observed between total CD4 + T cell counts (A + B + C) and probing depth (p = 0.0434) and between total CD4+ T cell counts and clinical attachment loss (p = 0.0268), but when the counts were grouped according to HIV stage (A, B and C), these associations were no longer evident (Table 3).
A noticeable but not significant difference was observed between smokers and non-smokers for total CD4+ counts (Table 4) but not for HIV stage (data not shown), although significant differences were observed between smokers and non-smokers for all of the clinical indices, with the exception of the gingival index (Table 4).
A greater percentage of HIV patients on ART belonged to Group B, while many of the Group A patients were not on ART (Table 5). Pearson's chi-square test indicated a highly significant difference between HIV stage and ART (Table 5).
The median for CD4+ T cell counts of patients on ART was higher than for those not on ART, with a highly significant positive relationship found between total CD4 + T cell counts and ART (Table 6). ART significantly influenced probing depth (p = 0.0065) and clinical attachment level (p = 0.0029), while no significant relationships were found between ART and plaque index, nor between ART and gingival index.
When questioned about frequency of visits to the dentist, 19% of the cohort reported never seeing the dentist, 52% said they saw a dentist once in 5 years and the remainder (29%) claimed they had visited the dentist 2 or more times in the past 5 years.
The majority (70%) reported brushing once a day, while only 30% brushed twice a day. Only 26% reported using interdental aids. A significant difference (p = 0.0352) was observed for plaque index scores of patients who brushed twice a day compared with those who brushed once a day. None of the other clinical indices showed any correlation with frequency of brushing (Table 7). With the exception of probing depth, all the clinical indices were significantly associated with the use of interdental aids (Table 7). The association of clinical indices with CD4+ counts was also significantly improved with adequate oral hygiene practices (Table 7).
Results
Table 1 shows the descriptive statistics of age, CD4 + T cell counts and periodontal indices of the 120 HIV-positive patients included in the study. The mean age was 33.25 years with a median age of 32 years (range: 20–55). The mean values for plaque index, gingival index, probing depth and clinical attachment loss were 2.55, 2.75, 4.77 mm and 5.29 mm respectively.
The mean CD4 + T cell count was 293.43 cells/mm (Table 1). When grouped according to their CD4 + T cell counts into groups with <200 cells/mm (Group A), 200–500 cells/mm (Group B) and >500 cells/mm (Group C), 30% of the patients were assigned to Group A, indicating severe immunosuppression (Table 1), 59.17% to Group B, a moderate degree of immunosuppression, with Group C (11%) indicating a wide range of immune competence (510–859 cells/mm, Table 1). Figure 1 shows the breakdown of CD4 + T cell counts into intervals of 100, plotted against the CD4+ midpoint.
(Enlarge Image)
Figure 1.
Frequency distribution of CD4 + T cell counts grouped into intervals of 100 and plotted against the midpoint.
Although, plaque and gingival indices showed positive (0.01514) and negative (−0.01133) correlations with CD4 + T cell counts, no significant associations were reflected in the p values, (Table 2). However, significant correlations were indicated between clinical indices (PD, CAL) and the total CD4+ count (A + B + C). Figure 2 demonstrates the positive Spearman's correlation between clinical attachment level and CD4 + T cell counts. The lack of a correlation between individual groups A, B and C, with any of the clinical indices (Table 2), shows that the prevalence of periodontal disease in HIV-positive patients may not directly be related to the different stages of immunosuppression even though total CD4+ counts could be associated with changes observed in the periodontal measurements.
(Enlarge Image)
Figure 2.
Correlation of CD4 + T cell counts with clinical attachment level.
Influence of Age on Clinical Indices
With an age range of 20–55 years (Table 1), we used Spearman rank correlation to examine whether age influenced the measurement of periodontal indices. Age was related to the clinical indices regardless of the patients' CD4 + T cell counts or their stages of immunosuppression. A highly significant positive correlation was found between age and plaque index (p = 0.0018) with a significant correlation with gingival index and probing depth (Table 3). However the level of clinical attachment showed no significant correlation with age.
Influence of HIV Stage on Clinical Indices
Significant associations were observed between total CD4 + T cell counts (A + B + C) and probing depth (p = 0.0434) and between total CD4+ T cell counts and clinical attachment loss (p = 0.0268), but when the counts were grouped according to HIV stage (A, B and C), these associations were no longer evident (Table 3).
Influence of Smoking on Clinical Indices
A noticeable but not significant difference was observed between smokers and non-smokers for total CD4+ counts (Table 4) but not for HIV stage (data not shown), although significant differences were observed between smokers and non-smokers for all of the clinical indices, with the exception of the gingival index (Table 4).
Association Between HIV Stage and Anti-retroviral Therapy (ART)
A greater percentage of HIV patients on ART belonged to Group B, while many of the Group A patients were not on ART (Table 5). Pearson's chi-square test indicated a highly significant difference between HIV stage and ART (Table 5).
Influence of ART on Clinical Indices
The median for CD4+ T cell counts of patients on ART was higher than for those not on ART, with a highly significant positive relationship found between total CD4 + T cell counts and ART (Table 6). ART significantly influenced probing depth (p = 0.0065) and clinical attachment level (p = 0.0029), while no significant relationships were found between ART and plaque index, nor between ART and gingival index.
Influence of Oral Health Care on Clinical Indices
When questioned about frequency of visits to the dentist, 19% of the cohort reported never seeing the dentist, 52% said they saw a dentist once in 5 years and the remainder (29%) claimed they had visited the dentist 2 or more times in the past 5 years.
The majority (70%) reported brushing once a day, while only 30% brushed twice a day. Only 26% reported using interdental aids. A significant difference (p = 0.0352) was observed for plaque index scores of patients who brushed twice a day compared with those who brushed once a day. None of the other clinical indices showed any correlation with frequency of brushing (Table 7). With the exception of probing depth, all the clinical indices were significantly associated with the use of interdental aids (Table 7). The association of clinical indices with CD4+ counts was also significantly improved with adequate oral hygiene practices (Table 7).
Source...