A condição bucal e à infecção pelo HIV/AIDS

Abstract

Introduction: Dental care has been an ally of primary care for human immunodeficiency virus (HIV) infection since the early 1980s, when practically all infected patients had some oral manifestation in the form of opportunistic infection related to disease progression. These manifestations included candidiasis, periodontal disease, hairy leukoplakia, herpes simplex, kaposi's sarcoma, and nonHodgkin's lymphoma which have been described as frequently related to acquired immunodeficiency syndrome (AIDS). Objective: To investigate factors associated with oral condition and HIV infection. Methods: This is a cross-sectional, exploratory study using a data collection instrument applied to patients with HIV/AIDS infection, users of the Specialized Care Service (SAE), in the city of Francisco Beltrão, in Southwest region of Paraná. Sociodemographic characteristics, health conditions and oral status were researched. Data were obtained through the application of a questionnaire, filled in from an interview, oral examination and information contained in clinical records. Oral examinations were performed to identify intraoral lesions and dental evaluation to perform the decayed, lost and restored permanent teeth (CPOD) index. To determine the CPO-D index, the diagnostic criteria for dental caries adopted in the Technical Project of the SBBrasil Project 2010 were used. The presence of oral manifestations in the individuals surveyed was recorded, according to the EC-Clearinghouse's classification of oral lesions associated with HIV infection. Oral mucosa samples were collected from all patients using a sterile swab. The swab was deposited in a tube containing one milliliter of 0.1% peptone water. The phenotypic identification of the isolated yeasts served for the presumptive determination of the species and was based on the observation of the morphology of the colonies grown at 25ºC for 5 days in Candida CHROMagar differential selective medium. The measure of strength of association adopted was the Prevalence Ratio (PR). Comparisons of continuous variables were made by Welch's t test and 2x2 categorical variables were examined using nonparametric techniques (e.g., Chisquare, with or without continuity correction and Fisher's Exact Test). Finally, Poisson regression with robust errors was used to obtain the adjusted PR. Results: The study sample consisted of 104 individuals, the majority, 53 (50.96%) being female, with a mean age of 41.59 years, ranging from 19 to 78 years. The predominant marital status was single, 39 (40.62%), 53 (58.88%) were white with a mean of completed years of schooling of 9.23 years. The current mean viral load was 5207.09; while the count of T4 or T-helper lymphocytes (T CD4+) had a mean of 299.63. There is a higher prevalence (12%) of erythematous candidiasis, followed by aphthous ulcers (9%), linear gingival erythema (9%) and pseudomembranous candidiasis with a prevalence of 4%. The other manifestations: angular cheilitis, herpes simplex and acute necrotizing ulcerative gingivitis (ANUG) had an estimated prevalence of 3% each, with human papillomavirus and hyperplastic candidiasis occurring in 1% each. Conclusion: After the introduction of antiretroviral therapy (ART), there was a decrease in the prevalence of oral manifestations, although its prevalence is still high (39%), and dental care is essential to maintain the general health of the individual with HIV/AIDS.