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The association between oral disease and type of antiretroviral therapy among perinatally HIV-infected youth

Shiboski, Caroline H.a; Yao, Tzy-Jyunb; Russell, Jonathan S.b; Ryder, Mark I.a; Van Dyke, Russell B.d; Seage, George R. IIIc; Moscicki, Anna-Barbarae for the Pediatric HIV/AIDS Cohort Study

doi: 10.1097/QAD.0000000000001965

Objectives: This study explores the association between combination antiretroviral therapy (cART) and oral health outcomes (dental and periodontal) among perinatally HIV-infected (PHIV) youth.

Methods: We conducted a cross-sectional study of oral health among PHIV youth participating in the Oral Health substudy of the Pediatric HIV/AIDS Cohort Study (PHACS). Dentists at research sites were trained/calibrated on how to perform a standardized oral mucosal, dental and periodontal examination. They assessed the decayed-missing-filled-surfaces and teeth index (DMFS/T). The number of decayed surfaces and teeth and the number of teeth with gingival bleeding on probing for each participant were derived from the examination. Data for analysis included lifetime measurements of CD4+ cell count and viral load, sociodemographic information and current/past history of ART.

Results: Among 209 PHIV youth, 95% were on ART at the time of enrolment. Among 143 PHIV youth on the same cART for at least 1 year, we found that the mean decayed teeth score of those receiving cART containing an integrase inhibitor was 86% higher than that of those on cART without an integrase inhibitor after adjusting for age, lifetime proportion of unsuppressed viral load and CD4+ cell count nadir. Initiating protease inhibitors before age 6 years was associated with a significantly lower DMFT score than participants who initiated at age 6 years and older.

Conclusion: Our study revealed that PHIV youth who received cART containing an integrase inhibitor had a significantly higher number of untreated active caries than those on cART without an integrase inhibitor. This may warrant closer dental surveillance of those receiving an integrase inhibitor.

aDepartment of Orofacial Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California

bCenter for Biostatistics in AIDS Research (CBAR)

cDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

dSchool of Medicine, Tulane University, New Orleans, Louisiana

eDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, Los Angeles, California, USA.

Correspondence to Caroline H. Shiboski, DDS, MPH, PhD, Department of Orofacial Sciences, University of California San Francisco, Box 0422, Room S612, 513 Parnassus Avenue, San Francisco, CA 94143-0422, USA. Tel: +1 415 476 5976; fax: +1 415 476 4204; e-mail:

Received 12 November, 2017

Accepted 2 April, 2018

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Copyright © 2018 Wolters Kluwer Health, Inc.