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. Riley et al (3) studied the periodontal health status of 200 HIV+ subjects and reported the following findings:
Good gingival health 85 patients Gingivitis 59 patients Adult periodontitis 49 patients Advance adult periodontitis 5 patients NUP 2 patients
The periodontitis of the patients in this survey did not have unique or pathognomonic characteristics which could set their periodontal disease apart from the periodontal disease seen in HIV- population.
Masouredis et al (4) 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. (5) 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 Glick et al (6) conducted a prospective study among 700 ambulatory HIV-infected individuals seeking dental care between July 1, 1988 and June 30, 1992. Patients entered the study when they first applied for care and were followed at regular intervals unless death occurred before the conclusion of the study. The prevalence rate (NUP) was calculated for the entire population and specific to race, gender, and HIV transmission category. Survival analysis was used to estimate the cumulative probability of death within 24 months of a NUP diagnosis. The association between NUP diagnosis and CD4+ cell count below 200 cells/mm3 was also investigated, and it was found that HIV-infected individuals presenting with a diagnosis of NUP were 20.8 times as likely to have a CD4+ cell count below 200 cells/mm3 compared to HIV-infected individuals presenting without NUP. The prevalence of NUP was 6.3%. The lesion was significantly more common among men having sex with men (MSM), 8.4%, compared with non-MSM males, 1.8%. No racial difference was noted. The mean CD4+ cell count for patients with NUP was 51.8 cells/mm3 (SD +/- 71.2) while the median CD4+ cell count was 32.0 cells/mm3. The predictive value of a CD4+ cell count below 200 cells/mm3 in patients with this lesion was 95.1%. A cumulative probability of death within 24 months of a NUP diagnosis was 72.9%.