LOSS OF PERIODONTAL ATTACHMENT IN HIV-SEROPOSITIVE MILITARY PERSONNEL

THE CROSS-SECTIONAL RELATIONSHIP between severe loss of periodontal at tachment (LPA) and worsening immune status due to HIV infection was ev aluated in 474 HIV-infected subjects (416 men, 58 women) aged 18 to 49 years who had been classified at stages 1 through 6 of the Waiter Ree d Army Institute of Research (WR) Staging Classification System. LPA w as measured at four sites per tooth using a manual probe; severe LPA w as defined as greater than or equal to 1 site/subject exhibiting great er than or equal to 5 mm LPA. Severe LPA was found in 94 (20%) of the subjects. Modeling with multiple logistic regression analysis revealed that WR stage and peripheral CD4+ lymphocyte cell counts were not sig nificant independent predictors of severe LPA. Severe LPA was more com mon in subjects at WR stage 5 or 6 who exhibited oral candidiasis (OC) , a marker of immune system damage, than in persons at those WR stages without OC (odds ratio = 7.85; 95% confidence interval (CI) = 1.94-31 .81). After the analysis controlled for WR stage, younger subjects rec eiving AZT had greater odds of severe LPA than same-age subjects not t aking the drug (e.g., odds ratio for subjects aged 30 years = 2.59; 95 % CI = 1.22, 5.49). Other significant predictors in the model included male sex; retired military status; cigarette smoking; and presence of cratered, ulcerated, or necrotic interdental papillae. HIV-associated immune deficiency may be associated with localized severe LPA, but th is may be an indirect association due to medication use, opportunistic infection, or other factors not captured by the WR staging system or peripheral CD4+ cell counts. Comparison with the estimated prevalence of HIV-associated periodontitis (HIV-P) in this population suggests th at infected persons may experience severe LPA that does not necessaril y have the clinical presentation of HIV-P.