Stomatologic complications in HIV positive patients: Clinical Correlations

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Original work:  Stomatologic complications in HIV positive patients: CLINICAL CORRELATIONS – DEMOGRAPHIC AND LABORATORY HOME> PUBLICATIONS> Volume 50 No. 1/2012> Received for arbitration: 09/03/2010 Accepted for publication: 26/01/2011 Flávio Domingos Saldanha PACHECO: Student Course Master of Oral Pathology, Graduate Program in Oral Pathology, Federal University of Rio Grande do Norte – UFRN, Natal / RN, Brazil. Manuel Antonio GORDÓN-NÚÑEZ: M. D. , Ph. D. Oral Pathology em, do Visiting Professor Department of Dentistry, Federal University of Rio Grande do Norte / Graduate Program in Oral Pathology – UFRN, Natal / RN, Brazil. Leonardo Miguel Madeira SILVA: Student of Dentistry, Department of Dentistry, Federal University of Rio Grande do Norte, Natal / RN, Brazil.

Giovani Kléber LIGHT: do Professor Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal / RN, Brazil. Cavalcanti Hébel GALVÃO: M. D. , Ph. D. Oral Pathology, Associate Professor II, Graduate Program in Oral Pathology, Federal University of Rio Grande do Norte – UFRN, Natal / RN, Brazil. Mailing address Hébel Cavalcanti Galvão Avenida Senador Salgado Filho, 1787. Lagoa Nova, Natal / RN, Brazil. CEP 59056-000 Tele / fax: + 55-84-3215-4138; E-mail: hebel. galvao@yahoo.

com. br / gordonnunez28@yahoo. com DENTAL COMPLICATIONS IN HIV POSITIVE PATIENTS: CLINICAL CORRELATIONS – DEMOGRAPHIC AND LABORATORY ABSTRACT The stomatologic complications are due to HIV infection, a lot of times, the first clinical signs of the disease. These injuries May Also function as beepers and sentries of the curse and progression of the HIV infection and AIDS. The objective of This work was to Evaluate the prevalence of the oral injuries in HIV positive Patients from the Hospital of Infected contagious Gizelda Trigueiro in Natal-RN, Brazil, and correlate them With demographic factors: such as gender, age, form of HIV infection and immune status (CD4 + T cells). CD4, According to the criteria of EC-CLEARINGHOUSE / WHO, through clinical oral examination and T + cell count 121 Patients Were EVALUATED. The oral candidiasis was The most common lesion (45. 2%), followed by oral hairy leukoplakia (16. 1%), linear gingival erythema (16. 1%), lips herpes (12.

9%), necrotizing periodontitis (6. 5%) and necrotizing gingivitis (3. 2% ) Predominantly occurring in men Between the ages 30 to 44 years, WHO HIV infection acquired through sexual contact. Based on the results of esta study, Concluded That there was a prevalence of the stomatologic complications profile That Is Commonly Reported in the literature. These Changes Were Associated with a decrease in the number of CD4 + T cells, Representing markers of the infection progression and / or failure of HAART, so a thorough oral examination is Important in clinical evaluation and follow up of Patients With HIV. Key Words: HIV, oral lesions, AIDS. Stomatologic complications in HIV positive patients: CLINICAL CORRELATIONS – DEMOGRAPHIC AND LABORATORY SUMMARY The (EC) stomatological complications in HIV + patients are often the first clinical signs of the disease and can function as signaling the course and progression of HIV infection and AIDS. This study assessed the prevalence of HIV + patients oral lesions ee Hospital Infectious Diseases Gizelda Trigueiro, in Natal-RN, Brazil and correlate with socio-demographic factors such as gender, age, mode of transmission and immune status. According to the criteria of the EC-CLEARINGHOUSE / WHO, through oral clinical examination and counting of CD4 + T cells were evaluated 121 HIV + patients. The most frequent injuries were candidiasis (45. 2%), hairy leukoplakia (16.

1%), erythema gingival linear (16. 1%), cold sores (12. 9%), necrotizing periodontitis (6. 5%) and necrotizing (3. 2%) gingivitis, occurring more often in men between the ages of 30-44 years who acquired HIV through sexual contact. Based on the results of this study conclude that there was a prevalence of stomatological profile complications commonly reported in the literature. The lesions were associated with reducing the number of CD4 + cells, representing, therefore markers of the progression of virus infection and / or failure of HAART, if so, a comprehensive oral examination is important in the clinical evaluation and support for HIV patients. Keywords: oral lesions HIV, AIDS. INTRODUCTION The Acquired Immune Deficiency Syndrome, known worldwide as AIDS was first described in 1981 in the United States, gay men, who had in common a significant reduction in the cellular immune response. Currently considered a serious pandemic, AIDS is the advanced clinical manifestation of HIV infection in January. The main cause of the progression of AIDS in HIV-infected patients is-1 reduction of CD4 + T cells, responsible for the specific humoral immune response and cell mediated. With the commitment of the infected individual’s immune system becomes susceptible to opportunistic infections and other diseases that can lead to death in February.

Factors that predispose to the emergence of HIV related oral lesions include the number of CD4 + T cells less than 200 cells / mm3 and levels of HIV RNA in plasma greater than 300 copies / ul, besides the presence of xerostomia, oral hygiene 3. 4 poor and smoking. With the introduction of highly active antiretroviral therapy (HAART) has been observed considerable control of viral replication and reconstituting immune functions in patients with immunodeficiency induced by HIV, consequently, there was a significant reduction in late complications of that infection, including death, allowing greater survival in May. Studies of the prevalence of oral lesions associated with HIV has shown wide variations in different countries 6. The emergence of HAART has changed the profile prevalence of lesions were more frequent before in patients living with HIV. 7-10 In recent work, oral lesions associated with human papillomavirus (HPV) and salivary gland diseases related to HIV have been targeted as the most prevalent in HIV + patients 7,8,11. The importance of knowledge of the oral manifestations in HIV positive patients is that these demonstrations may often emerge as first clinical sign or teaching 12,13 Since the first descriptions, oral manifestations have assumed an important role because of its diagnostic and predictive value for the evaluation and disease progression 14. Thanks to new therapies, the prevalence of demonstrations that were more obvious, such as Kaposi’s sarcoma and hairy leukoplakia has been reduced dramatically. 14-16 Approximately 60% of HIV-infected individuals and 80% of AIDS have undertaken stomatology demonstrations. Oral candidiasis and hairy leukoplakia are considered important clinical indicators of the progression of HIV infection to AIDS box, mainly in places where specific tests are not performed. These lesions, along with Kaposi’s sarcoma, non-Hodgkin lymphoma, linear gingival erythema, necrotizing gingivitis and necrotizing periodontitis, are considered strongly associated with HIV infection 17.

The large number of stomatological complications reported in the literature on the importance alert to routine conducting thorough clinical examination of the oral cavity and on the definition of behaviors related to treatment and oral health promotion. They have high predictive value in assessing progression of AIDS 18. Based on the above, this study presents a quantitative analysis of the prevalence of most of oral complications, relating to socio-demographic factors such as gender, age, race, mode of transmission and time of antiretroviral therapy in HIV-positive patients with / or without AIDS treated at the Hospital of Infectious Diseases Gizelda Trigueiro in Natal / RN, Brazil, seeking to trace the profile of these manifestations in this population, aiming to contribute to the establishment of the main marker lesions disease progression and get information to develop preventive and enable more effective management protocols. MATERIALS AND METHODS Through this prospective descriptive epidemiological study were evaluated HIV-infected with laboratory results confirmed through ELISA and Western Blot tests and accompanied clinically in the outpatient sector Hospital of Infectious Diseases Giselda Trigueiro adult patients – HEIGT in Natal – RN / Brazil. Under strict biosecurity measures, by visual inspection and digital palpation, all patients underwent a thorough clinical examination of oral and perioral structures, made by two trained examiners and calibrated, following the diagnostic criteria and classification recommended by the EC-CLEARINGHOUSE / WHO (1993). The patients answered a questionnaire on demographics, such as gender, age, medical history, previous and current, as well as previous and current therapies, the form of HIV infection and immune status (CD4 + cells). We quantified the CD4 + T cells, by flow cytometry using monoclonal antibodies, with test reagents CD4 FACSCount BD (BD Biosciences), whose reading was made with the equipment FACounts BD (Becton Dickinson). The blood collection for laboratory tests was performed immediately after the completion of the oral examination, within a maximum period of 4 hours, in order to establish the number of CD4 + lymphocytes of the individual at the time of the oral exam. Taking into consideration the count of CD4 + T cells, the immune status of patients was classified into mild immunosuppression (> 500 cells / mm3); moderate immunosuppression (> 200 –