Variation of Oral Diseases by HIV Exposure Among Kenyan Children

Abstract

Background: Although the prevalence of Human Immunodeficiency Virus (HIV) has significantly declined globally, largely due to increased access to antiretroviral therapy (ART) and effective prevention strategies, the disease remains a significant public health challenge, particularly in sub-Saharan Africa. While much attention has been directed towards managing the clinical manifestations of HIV and preventing its transmission, there is growing interest in how the disease and the treatment regimens impact oral health and the prevalence of dental caries. Purpose: The aim of this study was to determine the impact of HIV exposure/treatment on 3-4-year-old Kenyan children. Methods: This is a baseline analysis of a longitudinal study that was conducted amongst 360 children, aged 3-4-year, drawn from 31 hospitals and clinics in West Kenya. The children were divided into three cohorts of 120 children based on HIV diagnosis: HIV-infected (HIV), exposed at birth but uninfected (HEU) and unexposed uninfected (HUU). Demographics and data from a standardized oral examination were collected, besides data on ART treatment regimens, duration, viral load and adherence (HIV group). Statistical analysis was conducted using descriptive statistics, t-test and regression analysis (P<.05). Results: The mean age of the 360 children was 3.4 years (SD:0.5) and 51% were female. The majority of children were enrolled in private school (47%) (public (22%); no school (31%)) and lived in rural (49%) (urban (35%), peri-urban (16%)) areas. HIV children had significantly greater prevalence (81%) of abnormal findings (submandibular lymphadenopathy parotid gland enlargement, geographic tongue, among others) compared with those in the HEU (60%) and HUU (54%) groups (P<.001). No significant differences in salivary pH, dmft/dmfs scores, dental caries, dental plaque or gingival bleeding upon brushing were found. Among HIV children, 93% of reported viral loads under the threshold of 1,000 copies/mL (well controlled) while ART treatment adherence threshold of above 90% was met by 78% of the patients. Conclusions: Children living with HIV with access to ART treatment have significantly more oral diseases than the HEU or HUU. Diagnosing and treating oral diseases in HIV impacted children would improve delivery of care by HIV health providers.