Association of HIV viral load with oral diseases

OBJECTIVE: The measurement of HIV viral load as a predictor of disease prog ression has revolutionized the medical management of HIV patients. In this study, oral diseases as measured by DMFT (decayed, missing and filled teeth ), periodontal assessment and oral Candida colonization, were related to HI V viral toad. Also correlated was HIV status assessments, including CD4(+) count, a history of intravenous drug abuse (IVDA) and the use of protease i nhibitor drugs. MATERIALS AND METHODS: Oral and periodontal examination, dental radiographs , and tongue swab for fungal culture was accomplished over a 2-month period on 39 HIV positive patients attending the University of Maryland Dental Sc hool. Twenty-eight (71.8%) of these patients had a history of IVDA. Viral l oad was measured by a quantitative RT-PCR. RESULTS: Among the patients with high viral load (>10 000 copies ml(-1)), 9 2.3% were found to have a history of IVDA. Also, patients with high viral l oad demonstrated average CD4(+) counts of 136 mm(-3) while moderate viral l oad (400-10 000 copies ml(-1)) corresponded to average counts of 271 mm(-3) . Periodontal pocket depths (PPD) of >5 mm at a minimum of two oral sites w ere found in 76.9% of the patients with high viral load. Among the high vir al load patients, 69.2% had DMFT >20, 69.2% were culture positive for Candi da and 81.5% of patients on protease inhibitors demonstrated moderate or lo w viral loads. CONCLUSION: These data demonstrated that elevated viral load levels correla te well with oral disease prevalence in this predominantly IVDA population of HIV-infected dental patients.