Tanner (1) reports that several studies indicate a strong association of Actinobacillus actinomycetemcomitans with localized juvenile periodontitis that include Bacteroides forsythus, Porphyromonas gingivalis, Prevotella intermedia, A. actinomycetemcomitans, and Wolinella recta are associated with adult periodontitis. Likewise a still not named spirochete in the family of Treponema pallidum has been identified in ANUG. Further he states that species isolated from human immunodeficiency virus gingivitis and periodontitis are similar to those isolated from periodontal and gingival infections. Microbial identification aids in antibiotic selection and in planning a treatment regimen.
Laskaris et al. (2) reported the gingival lesions in 178 HIV infected patients classified as follows:
HIV+ 42.3% or 77 patients ARC 29.7% or 53 patients AIDS 27.0% or 48 patients
The mean age of the patients was 36.6 years; 158 (89%) were men and 20 (11%) were women. A total of 60 patients (34%) presented some form of periodontal involvement. The most common gingival lesions encountered in those patients were as follows:
Necrotizing ulcerative periodontitis 18.5% or 33 patients Necrotizing stomatitis 10.1% or 18 patients Candidiasis 5.8% or 10 patients Linear erythematous gingivitis 5.0% or 9 patients Kaposi's sarcoma 5.0% or 9 patients
Intra oral lymphomas and other lesions were recorded in low numbers. Masouredis et al (3) reported the prevalence of periodontal disease in 136 HIV infected patients in a San Francisco AIDS Clinic. The periodontal lesions were classified as HIV associated gingivitis (today LGE), HIV associated periodontitis (today NUP) and conventional non-HIV associated periodontal disease. The diagnosis was based on defined clinical criteria established before the study began. For the HIV-associated diseases, two sets of diagnostic criteria were used. One consisted of clinical signs that included bleeding on probing, pocket depth, and attachment loss; and the other consisted of the same signs but did not require probing. Using the first set of these criteria the following diagnoses were established:
HIV-G 42 patients or 31% HIV-P 5 patients or 4%
Using the second set of criteria the following diagnoses were established:
HIV-G 68 patients or 50% HIV-P 8 patients or 6%
All other categories of periodontal disease that were non-HIV-associated were diagnosed in 60 (44%) of patients.
Klein et al. (4) studied the prevalence of periodontal disease in 181 heterosexual men and women with AIDS. The group was composed as follows:
Intravenous drug users (IVDU) 167 (92%) Sexual partners of persons at risk for AIDS 14 (8%)
Periodontal disease was present in:
Women 71 of 78 (91%) Men 75 of 103 (73%).
Gingivitis was the most severe form of periodontal disease seen in:
Women 7 (9%) Men 15 (15%).
Increased severity of periodontal disease was seen in women when compared with men; among subjects with periodontitis, 48 (75%) of 64 women had moderate to advanced disease compared to 32 (53%) of 60 men. For individuals with periodontitis, the extent of involvement was associated with severity; 90% of subjects with advanced periodontitis had all 4 quadrants affected. Candidiasis, hairy leukoplakia, ulcers and Kaposi's sarcoma were present in 167 (92%) subjects. The authors concluded that HIV-associated gingivitis and HIV-associated periodontitis are common in heterosexual men and women with AIDS and are often accompanied by other oral manifestations of AIDS. Clinicians should consider that these disorders occur in heterosexual as well as in homosexual men.
Grbic et al (5) evaluated the periodontal status in two cohorts participating in a study of HIV infection. One cohort consisted of:
121 homosexual men (HM), (77 HIV+ and 44 HIV-), the other cohort had: 83 parenteral drug users (PDU), (44 HIV+and 39 HIV-). No differences were observed between HIV+ and HIV- individuals within a cohort in terms of clinical periodontal parameters (percent of sites with > or = 4 mm probing depth, percent of sites exhibiting bleeding on probing, mean oral hygiene index). The PDU displayed more periodontal disease than the HM. Periodontal disease in the HIV+ individuals in both cohorts was not directly related to the number of CD4+ lymphocytes. Linear gingival erythema (LGE) was observed in all 4 groups. HIV+ HM displayed more LGE than HIV- HM (16.6% vs. 11.4%) and HIV- PDU displayed more LGE than HIV+ PDU (38.5% vs. 29.5%), neither difference was significant. LGE tended to be related to reduced numbers of CD4+ lymphocytes. A statistically significant relationship was found between the presence of intraoral candidiasis and LGE in HIV+ HM: 42.9% of these subjects with candidiasis had LGE, while only 12.7% of the subjects without candidiasis had LGE . For the HIV+ PDU, 35.3% of the individuals with candidiasis had LGE and 25.9% of the subjects without candidiasis displayed LGE, but the difference was not statistically significant.