Western Society of Periodontics

Clinical Studies

Volume Number 4, 1995

Loss of periodontal attachment in HIV-seropositive military personnel

This clinical study of military personnel testing seropositive for HIV had the following objectives: (1) estimate the prevalence of severe loss of periodontal attachment (SLPA) in an HIV-infected population; (2) compare the prevalence of SLPA at various stages of HIV disease; (3) identify behavioral, clinical, and biological markers associated with increased odds of SLPA; (4) construct statistical models to help explain the occurrence of SLPA in HIV-infected individuals; and (5) compare the SLPA attributable in the study population to HIV-related damage to the immune system to the estimated prevalence of HIV-P.

In this cross-sectional study, 474 military personnel were used, and data was collected at baseline oral examinations given between 1989 and 1993. Self-reported data were collected on demographic characteristics, dental care, oral symptoms, use of tobacco, and other factors. The Walter Reed (WR) Staging Classification System was used to identify the disease progression. Loss of periodontal attachment was measured at four sites per tooth using a manual probe; SLPA was defined as one or more sites/subjects exhibiting 5 mm or more LPA. Other clinical measurements included gingival bleeding plaque and calculus indices, character of interdental papillae, and presence of erythematous gingival banding.

Overall, 19.8% of the study subjects had SLPA (more men than women). The odds of SLPA tended to increase with worsening severity of HIV disease. Subjects with plaque or calculus index scores above the group median were more likely to have SLPA. SLPA was significantly associated with the presence of a high number of erythematous, edematous, or cratered interdental papillae; banding had no association. Oral candidiasis subjects were more likely to have SLPA, and the strength of association between OC and SLPA increased with advancing stages of HIV disease. The WR stage of HIV disease was not a significant independent correlate.

The current investigation suggests that HIV-associated immune deficiency may be associated with SLPA that does not present as the HIV-associated periodontitis described. Neither the WR staging nor peripheral CD4+ T-lymphocyte counts maybe adequate markers for the immune system changes involved in the pathogenesis of periodontal destruction in HIV-infected individuals. [D.S.S.]