口腔医疗机构艾滋病职业暴露及职业防护的研究进展

艾滋病（AIDS）是由人类免疫缺陷病毒（HIV）引起的一类传染性极强、蔓延速度快、病死率高的传染性疾病,是我国公众健康及传染病防治中的一个难题。口腔诊疗工作的特征,使口腔医疗机构/口腔科成为HIV/AIDS职业暴露的重点部门,医务人员面临较高的HIV/AIDS职业暴露风险。本研究对HIV/AIDS的流行状况及传播途径、HIV/AIDS患者口腔病变、口腔医疗机构HIV/AIDS职业暴露及职业防护的现状进行综述。     

口腔医务人员对HIV职业性暴露的风险及防护

艾滋病(AIDS)是一种严重威胁人类健康的传染病，已成为严重的公共卫生问题。根据联合国艾滋病规划署和世界卫生组织(WHO)的最新统计数据，2002年全球共有人类免疫缺陷病毒(HIV)携带者和AIDS患者约4200万，比2001年新增500万，2002年因AIDS死亡人数有310万。     

口腔医务人员职业暴露分析

目的：了解口腔医务人员职业暴露的状况,分析其发生的危险因素并探讨防范措施,为降低职业暴露的风险提供参考。方法回顾2013年1月—2015年12月44例口腔医务人员发生职业暴露的登记数据,对其职业、暴露源、暴露种类、暴露环节等进行分析。结果44例职业暴露者以医生和护士为主,分别占54.5％和34.1％;其中发生锐器伤39例,黏膜暴露3例;暴露环节前两位是诊疗后整理器械或清洗器械、操作或手术时锐器刺伤,分别为19例（占43.2%）、15例（34.1%）;所有职业暴露者均及时进行妥当处理,随访暂未发现因职业暴露而导致医务人员感染。结论医生护士在诊疗中使用器械及诊疗后处理器械是发生职业暴露的高危环节。     

口腔临床实习医师职业暴露防护现状和教育策略

职业暴露是指医务人员从事诊疗、护理等工作过程中意外被乙肝、丙肝、艾滋病病毒等感染者或者病人的血液、体液污染皮肤或者黏膜,或者被含有病毒的血液、体液污染的针头及其他锐器刺破皮肤,有可能被病毒感染的情况。近年来,医院感染的发生率逐年增加,已成为我国乃至全球的公共卫生问题。特别是口腔医护人员,他们需要频繁使用锐器[1],各种医疗器械均会与患者的血液、唾液直接接触。在医务人员职业暴露后,沾有患者血液、唾液的医疗器械便会传播[2],口腔医护人员感染的机会大大增加。口腔医务人员的乙肝感染率是一般人群的3~6 倍,在医疗行业中口腔医务人员乙肝感染率也是最高的[3]。     

性传播疾病的口腔表征(一)--艾滋病的口腔表征及医护人员的防护

1概述1.1艾滋病的发现艾滋病的全称为获得性免疫缺陷综合征(Acqu ired Immu-nodefic iency Syndrom e,AIDS),由人类免疫缺陷病毒(Hum an Im-munodefic iency V irus,H IV)感染所引起。中译名为艾滋病。人类关于艾滋病的确切记载始于1981年。第一次有关AIDS患者的报道是在1981-0     

HIV感染患者的口腔表征及研究进展

艾滋病是当今最受关注的传染病之一,它具有传播速度快、波及地区广和死亡率高的特点。对艾滋病的研究认为:大多数艾滋病患者可出现口腔症状,多首诊于口腔科,因此艾滋病口腔表征作为早期诊断的关键症状,已引起国际医学界的高度重视。本文综合近年来国内、外的有关文献,对HIV感染者的口腔表现作一综述。     

获得性免疫缺陷综合征患者的口腔表征及防治的研究进展

本文对获得性免疫缺陷综合征(简称艾滋病)患者的相关口腔疾病及防治的研究进展作一综述,以提高口腔医务工作者对艾滋病的警惕性,增强自我保护意识。     

口腔医护人员传染病职业暴露危险因素及防护

口腔医护人员长期暴露在各种致病因素之中,其中对传染病病原体的暴露是威胁口腔医生身体健康的一个重要因素。病原微生物在口腔诊疗过程中传播的基本途径有:血源性传播、飞沫传播、接触传播以及气溶胶传播。通过这些途径,微生物群落如朊毒体、病毒、真菌、细菌等得以传播。2019年12月以来,随着由2019新型冠状病毒(2019-nCoV、SARS-CoV-2)引起的新型冠状病毒肺炎(COVID-19)在武汉爆发,口腔诊疗过程中产生的气溶胶带来的感染风险也迅速被人重视。本文总结目前人们对传染性疾病在口腔诊疗环境中传播和风险因素的相关研究,以便口腔临床医生参考,做好相关的防护,避免职业暴露的发生。     

与人类免疫缺陷病毒感染和艾滋病相关的口腔疾病的研究进展

艾滋病（AIDS）在口腔的表现是艾滋病诊断的重要指标之一。多数人类免疫缺陷病毒（HIV）感染患者都有口腔表现，但口腔表现却往往被忽视。目前与HIV感染密切相关的主要口腔疾病有口腔黏膜病、牙周病、涎腺疾病及龋病等。本文对HIV感染和艾滋病相关的口腔疾病的研究进展作一综述。     

Oral manifestations of HIV infection in adult patients from the province of Sancti Spiritus, Cuba

Background:  Studies on the prevalence of HIV-related oral lesions (HIV-OL) have shown great variations among different countries. The aim of this study was to describe the prevalence of HIV-OL in adults infected with HIV in the province of Sancti Spiritus, Cuba, and to determine the factors associated with the presence of HIV-OL.
Methods:  A cross-sectional observational study was performed between November 2006 and August 2007 at the Hospital General Universitario 'Camilo Cienfuegos', Sancti Spiritus. One hundred and fifty-four HIV-infected patients were included. Patients were examined and interviewed by a periodontal specialist. Diagnosis of HIV-OL was based on clinical criteria. Demographical, clinical and laboratory data were obtained. Independent association of each factor with HIV-OL was assessed by logistic regression modelling.
Results:  The prevalence of HIV-OL was 40.9%. The commonest manifestation was oral hairy leucoplakia ( n  = 19; 12.3%); oral candidiasis ( n  = 17; 11%); herpes simplex virus infection ( n  = 11; 7.4%); and aphthous ulcer ( n  = 9; 5.8%). Principal factors associated with the presence of HIV-OL were CD4⁺ lymphocytes <500 cells/mm³ (OR: 2.06; 95% CI: 1.019–4.195) and smoking (OR: 2.03 CI: 1.037–3.982).
Conclusion:  This study described the prevalence of HIV-OL in 154 HIV-infected patients which represent about 80% of those known to be infected in the province of Sancti Spiritus. The prevalence of HIV-OL was lower than those reported from developing countries. Oral hairy leucoplakia and oral candidiasis were the most prevalent HIV-OL. Smoking and CD4⁺ cells count <500 cells/mm³ were the two factors independently associated with the presence of HIV-OL.     

Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria

OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.     

Multiple parotid lymphoepithelial cysts in patients with HIV-infection: report of two cases

OBJECTIVE: Bilateral and multiple lymphoepithelial cysts (LECs) of major salivary glands, in particular of parotid glands, are quite rare and have been reported in human immunodeficiency virus (HIV) infected patients with an incidence of about 3-6%. These lesions represent an early manifestation of HIV infection and are rarely found in patients with advanced acquired immunodeficiency syndrome. MATERIALS: Two cases of parotid LECs, the first occurring in a middle-age white woman and the second in a young white boy, both in advanced phases of HIV infection, are reported. RESULTS: Clinical, cytological, histological and immunohistochemical (cytokeratin AE1/AE3, CD20, CD45RA, CD8, kappa and lambda immunoglobulin light chains, S-100, MLA and Ki67) features are described. CONCLUSIONS: Fine needle aspiration (FNA), a relatively non-traumatic procedure, could represent both a diagnostic and a therapeutic tool in parotid LECs. No surgical therapy is usually required for these lesions and aspiration of cystic fluid with FNA is quite resolutive, although evidence of further relapses does exist. Surgical excision may become necessary when pain, because of persistent and progressive swelling of the parotid gland, occurs.     

口腔微生物与肿瘤关系的研究进展

口腔幽门螺杆菌与胃部肿瘤关系的研究,引发了对口腔微生物与肿瘤之间关系研究的热潮。本文从口腔幽门螺杆菌与胃部肿瘤的关系,口腔微生物群落与口腔鳞状细胞癌的关系,以及人类免疫缺陷病毒感染患者口腔微生物群落与肿瘤的特殊且密切的关系三个方面对口腔微生物群落与肿瘤之间的关系进行综述,对口腔微生物与肿瘤关系的进一步研究提供参考,以实现通过检测口腔微生物对肿瘤患者进行早期诊断,甚至辅助治疗的目的。     

Oral bacteria induce a differential activation of human immunodeficiency virus-1 promoter in T cells, macrophages and dendritic cells

Introduction:  The human immunodeficiency virus (HIV) can integrate into T cells, macrophages and dendritic cells resulting in a latent infection. Reports have also demonstrated that various microbial and host cell factors can trigger HIV reactivation leading to HIV recrudescence, potentially undermining highly active antiretroviral therapies.
Methods:  This study evaluated the capacity of oral bacteria associated with chronic periodontal infections to stimulate HIV promoter activation in various cell models of HIV latency.
Results:  T cells (1G5) challenged with oral bacteria demonstrated a dose–response of HIV promoter activation with a subset of the bacteria, as well as kinetics that were generally similar irrespective of the stimuli. Direct bacterial challenge of the T cells resulted in increased activation of approximately 1.5- to 7-fold over controls. Challenge of macrophages (BF24) indicated different kinetics for individual bacteria and resulted in consistent increases in promoter activation of five fold to six fold over basal levels for all bacteria except Streptococcus mutans . Dendritic cells showed increases in HIV reactivation of 7- to 34-fold specific for individual species of bacteria.
Conclusion:  These results suggested that oral bacteria have the capability to reactivate HIV from latently infected cells, showing a relationship of mature dendritic cells > immature dendritic cells > macrophages ≥ T cells. Expression of various pattern recognition receptors on these various cell types may provide insight into the primary receptors/signaling pathways used for reactivation by the bacteria.     

Oral bacteria induce a differential activation of human immunodeficiency virus‐1 promoter in T cells,macrophages and dendritic cells

Introduction: The human immunodeficiency virus (HIV) can integrate into T cells, macrophages and dendritic cells resulting in a latent infection. Reports have also demonstrated that various microbial and host cell factors can trigger HIV reactivation leading to HIV recrudescence, potentially undermining highly active antiretroviral therapies. Methods: This study evaluated the capacity of oral bacteria associated with chronic periodontal infections to stimulate HIV promoter activation in various cell models of HIV latency. Results: T cells (1G5) challenged with oral bacteria demonstrated a dose–response of HIV promoter activation with a subset of the bacteria, as well as kinetics that were generally similar irrespective of the stimuli. Direct bacterial challenge of the T cells resulted in increased activation of approximately 1.5‐ to 7‐fold over controls. Challenge of macrophages (BF24) indicated different kinetics for individual bacteria and resulted in consistent increases in promoter activation of five fold to six fold over basal levels for all bacteria except Streptococcus mutans. Dendritic cells showed increases in HIV reactivation of 7‐ to 34‐fold specific for individual species of bacteria. Conclusion: These results suggested that oral bacteria have the capability to reactivate HIV from latently infected cells, showing a relationship of mature dendritic cells > immature dendritic cells > macrophages ≥ T cells. Expression of various pattern recognition receptors on these various cell types may provide insight into the primary receptors/signaling pathways used for reactivation by the bacteria.     

Matrix metalloproteinases and their inhibitors in gingival mast cells in persons with and without human immunodeficiency virus infection

BACKGROUND: Mast cells are a prominent cell type in the gingival infiltrate in periodontitis. In this study we examined the expression by gingival mast cells of matrix metalloproteinases, MMP-1, MMP-2, MMP-8 and the tissue inhibitors of metalloproteinases, TIMP-1 and TIMP-2. METHODS: Gingival specimens from 12 human immunodeficiency virus-negative (HIV-) and 15 HIV-positive (HIV+) patients with chronic marginal periodontitis (CMP), and from 10 HIV- and four HIV+ controls with clinically healthy gingiva (HG) were examined after double immunofluorescence staining for mast cell tryptase, combined with antibodies for MMP-1, MMP-2, MMP-8 or their inhibitors TIMP-1 and TIMP-2. RESULTS: In the HIV+CMP, HIV+HG and HIV-CMP groups, all mast cells expressed MMP-1 and MMP-8, whereas a smaller proportion (40-60%) in the HIV-HG controls displayed such staining. The former groups also displayed a significantly higher proportion (39-64%) of mast cells expressing MMP-2 as compared with the HIV-HG group (21-31%). All groups displayed similar proportions of TIMP-1 expressing mast cells (86-100%), whereas significantly increased proportions of TIMP-2+ mast cells were seen in the HIV+CMP, HIV+HG and HIV-CMP groups (18-25%) as compared with the HIV-HG group (8-13%). Mast cells were the cell type that most prominently expressed MMP-1 and MMP-8. MMP-2 expression was also strong in mast cells, but was also similarly expressed in other cell types. CONCLUSION: The chronically inflamed periodontal lesions in the present study appeared with little evidence of mast cell degranulation. The results show, however, that mast cells in inflamed gingiva have the potential to degrade extracellular matrix if appropriately triggered.