Immune reconstitution inflammatory syndrome in HIV infection: taking the bad with the good

In this review, we will describe the immunopathogies of immune reconstitution inflammatory syndrome, IRIS. IRIS occurs in a small subset of HIV patient, initiating combination antiretroviral therapy (ART), where immune reconstitution becomes dysregulated, resulting in an overly robust antigen‐specific inflammatory reaction. We will discuss IRIS in terms of the associated coinfections: mycobacteria, cryptococci, and viruses.     

Association of HIV and parotid cysts]

Parotid cystics are included in salivary glands affection, found with persons infected by the human immunodeficiency virus. This study reports 28 cases registered in the oto-rhino-laryngology service of Brazzaville university hospital. The interested age is between 32 and 57 years old. The HIV profile reveals a prevailing of HIV1 (20 cases). The dia-gnosis is clinical, echographic and by the exploratory puncture. The therapeuratic approach (iterative puncture and compressive dressing) adopted to these brittle patients and with limited resource, permitted to get satisfactory results.     

Knowledge and attitudes towards HIV/AIDS amongst Kuwait university dental students

The HIV and AIDS have emerged as complex health threats to the world population. As future dentists, it is pertinent that the dental students have sufficient knowledge and a positive approach towards the disease. Accordingly, the aim of this study was to assess the HIV/AIDS related knowledge and attitudes amongst clinical dental students at Kuwait University. A cross‐sectional survey was conducted amongst the clinical dental students using a structured questionnaire with 60 questions to examine their knowledge under various categories and 13 questions to examine their attitudes towards the disease. The survey revealed that almost 58% of the respondents demonstrated a high level of knowledge (mean score: 45.23 ± 4.35 SD). Majority of the students (63.6%) expressed negative attitude (mean score: 5.36 ± 2.56 SD). The mean knowledge score of the fifth year dental students was significantly higher (P = 0.022) than that of the final year dental students regarding the knowledge of virus and disease process. However, no significant difference was observed with respect to other knowledge categories. Despite their high level of knowledge, the majority displayed a negative attitude towards HIV/AIDS. Hence, the findings imply that there is a need to address, more clearly, the students’ misconceptions and attitudes towards the disease.     

A few good faculty

Faculty shortages have been in concern in dental academia for the past several years. The American Dental Education Association has taken the lead in bringing this issue to the forefront of dental education, creating initiatives that begin to turn academia into a worthwhile career option for dentists. Income opportunities, faculty development, lifelong learning and job satisfaction must all be addressed, in order to fill vacancies and avoid high turnover. Contemporary dental education needs faculty who don't just want a job: they need to want to create a career out of teaching. How we provide inspiration and preparation for these individuals throughout their careers is critical to dentistry's success.     

Benign parotid lymphoepithelial cysts associated with HIV infection

HIV infections are often related with lymphoepithelial benign cysts of the parotid gland; these lesions are uncommon and other salivary glands are rarely involved. The diagnosis, often difficult, is based on imaging techniques, like computed tomography, and pathologic techniques, like fine needle aspiration biopsy. The therapeutic approach can be performed by simple aspiration, surgical resection, pharmacotherapy, or radiotherapy. Three cases of HIV-related lymphoepithelial benign cysts of the parotid gland observed at the Department of Maxillofacial Surgery of the "Federico II" University of Naples and at the Department of Oral and Maxillofacial Surgery of "La Paz" Hospital of the Universitad Autonoma of Madrid are described.     

Control of HIV/AIDS and AIDS-related conditions in Africa with special reference to periodontal diseases

The HIV/AIDS pandemic, described as one of the worst in human history, is having devastating consequences on the African continent. With 70% of the world's HIV-infected population living in sub-Saharan Africa, the economic, social and health care challenges are staggering. While synthesis of effective vaccines is still at an early stage, containment of the pandemic requires a holistic response through an integrated approach of prevention, treatment and improvement in living conditions. Highly active antiretroviral therapy (HAART) has had a major impact on HIV-related deaths and illnesses. The goal of antiretroviral therapy is the maximum suppression of viral load, restoration or preservation of immune function, improvement of quality of life and reduction of HIV-related morbidity and mortality. The spectrum of periodontal diseases in individuals infected with HIV includes unusual forms of gingivitis, necrotising diseases, exaggerated periodontitis and a host of oral mucosal conditions. Treatment includes professional plaque control, debridement to remove necrotic debris, irrigation with antiseptic mouthwashes (chlorhexidine, povidone iodine) and the use of systemic antibiotics in selected cases. It is imperative that research continues in order to better understand the periodontal diseases associated with HIV-infected individuals and design evidence-based therapeutic regimens.     

Experiencing the "good life": literary views of craniofacial conditions and quality of life.

OBJECTIVE: This article is a qualitative approach to understanding how people with craniofacial conditions see quality in their lives and how they understand the components of building a sense of well-being or goodness in their lives. Literary selections from fiction, Web sites, and first-person accounts are examined and categorized into domains and themes to offer some insight into how quality of life is built into the lives of people with craniofacial conditions. Three domains are noted: (1) a personality and psychological domain; (2) a family, work, and social interactive domain; and (3) a cultural and societal domain. Within each domain, a number of themes are noted and discussed. Quotes from affected people and their families are offered to illustrate how they respond to and alter their lives and their world views. Many adults with craniofacial conditions find ways to live with their difference and to succeed using the measures they construct.     

Management of oral health in persons with HIV infection.

Prevention and treatment of oral disease is required to maintain quality of life and to improve prognosis of patients infected with the human immunodeficiency virus (HIV). Management requires a team approach, and close collaboration with the appropriate responsible physicians and other health care workers is necessary. Oral infection is frequent and usually opportunistic, and management is based on certain principles. Infections may disseminate and can be persistent and severe; multiple concurrent or consecutive infections with different microorganisms are frequent; fungal, viral, and parasitic infections are rarely curable; and long-term antimicrobial therapy may be required. This article reviews the management of oral candidiasis, hairy leukoplakia, and infections with herpes simplex virus, varicella-zoster virus, and cytomegalovirus. The management of Kaposi's sarcoma, lymphomas, aphthous ulceration, gangrenous stomatitis, bleeding, xerostomia, and adverse drug reactions is also described. Treatment should avoid further immunosuppression and inducement of xerostomia or caries, and should be designed to avoid adverse drug reactions and possible drug interactions.     

Oral ulcerations in HIV infection

Oral ulceration in HIV infection may be due to: (1) mycotic; (2) bacterial, protozoan; (3) and viral infections; (4) oral neoplasia; (5) aphthous ulceration/ulceration not otherwise specified (NOS); or (6) ulceration of iatrogenic origin. Of particular significance are oral ulcerations caused by viruses of the herpes virus group (HSV 1/2, CMV, VZV) and ulcerations of the aphthous type. It was shown recently that coinfection of viral ulcers occurs. The aetiopathogenesis of the aphthous type of ulcerations including the still debated ulceration NOS is not clear. Further basic and clinical research is necessary in order to better understand ulceration particularly in relation to immunoregulation, tissue breakdown and repair.     

How good are my grades?

Currently no index exists for quantifying the grading effectiveness of tests or evaluation systems. The existing literature in educational measurement is suggestive of solutions; however, many of the techniques are only applicable in special cases and the theoretical and computational foundations are difficult. An alternative, the Qa statistic, is proposed. This statistic is the estimated proportion of correctly graded students. It is an extension of the standard error of measurement and takes into account student observed scores, reliability of available score data, and instructor-determined grade cutoffs. A one-page, computer-generated Qa report is analyzed and implications for its use are discussed. Data are presented from a sample of 60 grading situations showing that increased testing produces small marginal increases in proportion of correctly graded students.     

HIV and dentistry. Part 3. HIV infection: pathogenesis, epidemiology, definitions and classification

The acquired immunodeficiency syndrome (AIDS) is caused by a retrovirus, the human immunodeficiency virus (HIV), that selectively deteriorates cell-mediated immunity. Consequently fatal opportunistic infections and/or malignancies occur. In this paper the pathogenesis and the epidemiology of HIV infection are described. In addition the 1993 revised classification for HIV infection and the expanded surveillance case definition for AIDS are presented.     

HIV topic update: oro-genital transmission of HIV

Several viruses, including the human immunodeficiency virus (HIV), can be found in blood and many body fluids including saliva, and are transmissible sexually across genital and particularly anal mucosae. A persisting concern has been the question of transmission of HIV by oral sexual practices. This review discusses the evidence for oro-genital transmission of HIV, detailing the presence and infectivity of HIV in genital fluids and saliva, the case reports and epidemiology of oro-genital HIV transmission, and the evidence from animal studies. Oral intercourse is not risk-free. The evidence suggests that the risk of HIV transmission from oro-genital sexual practices is substantially lower than that from penile-vaginal or penile-anal intercourse, that exposure to saliva presents a considerably lower risk than exposure to semen, and that oral trauma and ulcerative conditions might increase the risk of HIV transmission.     

Interplay between oral immunity in HIV and the microbiome

This Basic Science Workshop addressed the oral microbiome. At the 7th World Workshop on Oral Health & Disease in HIV/AIDS in India in 2014, some aspects of the human microbiome were discussed, and research questions formulated. Since that time, there have been major advances in technology, which have stimulated a number of publications on many aspects of the human microbiome, including the oral cavity. This workshop aimed to summarize current understanding of the “normal” microbiome of the oral cavity compared to that during HIV infection, and how oral immune factors and other clinical variables alter or control the oral microbiome. An important question is whether successful treatment with anti‐retroviral therapy, which leads to a significant drop in viral loads and immune reconstitution, is associated with any change or recovery of the oral microbiome. Additionally, the workshop addressed the issue of which parameters are most appropriate/correct to evaluate the oral microbiome and how clinically relevant are shifts/changes in the oral microbiome. The workshop evaluated current knowledge in five research areas related to five basic questions and identified further topics where further research is required.     

Transmission of HIV in the dental clinic and elsewhere

This review focuses on the risk of transmission of HIV in dental practice in developed and developing countries; and as a result of oral sex, perinatal transmission and breast feeding. Postexposure prophylaxis (PEP) and practical measures to control cross-infection with TB are also discussed. There are few data from resource-poor countries where prevalence of HIV and risk of infection are higher – issues that deserve priority. Available information indicates that the risk of HIV transmission in the dental office is very low. Transmission of HIV from three healthcare workers to patients has been confirmed, including a dentist who infected six patients. There are >300 reports (102 confirmed) of occupational transmission to healthcare workers, including nine dental workers (unconfirmed). Exposure to HIV has been reported by 0.5% dentists/year. The risk of HIV infection after percutaneous exposure (0.3%) can be reduced by 81% with zidovudine PEP. However, risk assessment is required to assess the need and appropriate regimen. The risk of HIV transmission associated with orogenital sex exists, but is considered extremely low: barrier protection is recommended. Conversely, the proportion of babies who acquire HIV from untreated HIV-seropositive mothers is 15–25% in developed countries and 25–45% in developing countries. The frequency of HIV transmission attributable to breastfeeding is 16%. Airborne transmission of TB can be avoided by the prompt referral of known/suspected cases of active TB for chemotherapy, deferral of elective procedures until patients are not infectious, and the use of appropriate standard/isolation precautions including adequate ventilation of treatment areas.     

Oral candidiasis in pediatric HIV patients

Oral candidiasis can be an early sign of illness or disease progression in HIV/AIDS and other immuno-compromised states. Oral lesions associated with fungal infections present in a variety of forms, including a few of previously unknown etiology. Diagnosing these variants of disease can be challenging because of their atypical clinical presentation. Moreover, the emergence of new candida species, drug resistance and immature immune systems add to the complexity of this condition, especially in children.     

Innate and adaptive mucosal immunity in protection against HIV infection

The appalling toll on the populations of developing countries as a result of the HIV epidemic shows no signs of abatement. While costly drug therapies are effective in developed nations, the sheer scale of the epidemic elsewhere makes the need for a vaccine an ever more urgent goal. The prevalent DNA prime-viral boost strategy aims to elicit cytotoxic lymphocytes (CTL) against HIV, but this approach is undermined by the rapid mutation of HIV, which thereby escapes CTL control. Alloimmunity has been found to be protective in vertical transmission from infected mothers to their babies, in alloimmunization of women with their partners' mononuclear cells, and in monkeys immunized with SIV grown in human T-cells. Vaginal mucosal immunization, as a result of unprotected sex with a regular partner, induced in vitro protection against HIV infection, and this was confirmed in macaques. The second type of natural protection is found in persons with the homozygous 32 CCR5 mutation, a 32-base-pair deletion of the CCR5 gene, which results in a lack of cell-surface expression of CCR5, which is associated with an increase in CC chemokines and the development of CCR5 antibodies. These two 'experiments of nature' have been used to develop vaccine strategies--first, in vaginal immunization of macaques with CCR5 peptides, in addition to HIV envelope (env) and SIV core (gag) antigens, all of which were linked to the 70-kD heat-shock protein (HSP70); and second, in mucosal allo-immunization of macaques, which also gave rise to in vitro protection from infection. Immunization with this vaccine elicited serum and vaginal IgG and IgA antibodies, IFNgamma- and IL-12-producing cells, and increased concentrations of CCL-3 and CCL-4. Vaginal challenge with a simian immunodeficiency virus engineered to carry a human envelope protein (SHIV 89.6) showed significant clearance of SHIV in the immunized macaques. This platform strategy will now be developed to activate the co-stimulatory pathways with the aim of enhancing the primary allogeneic and CCR5-directed responses which are involved in natural protection against HIV infection.     

Alteration in salivary function in early HIV infection

The etiology of salivary gland hypofunction in HIV(+) patients is unclear. This study was designed to determine the effect of early-stage HIV(+) infection (CD4(+) > 200 cells/ micro L; n = 139) on salivary gland function and the relationship of this dysfunction to the taking of xerostomic medications. Salivary flow rates and the content of electrolytes and antimicrobial proteins in stimulated parotid and submandibular/sublingual saliva were determined. Compared with healthy controls (n = 50), the HIV(+) group showed significant reductions in flow rates of unstimulated whole (35%), stimulated parotid (47%), unstimulated submandibular/sublingual (23%), and stimulated submandibular/sublingual (39%) saliva. The flow rates for the HIV(+) patients taking xerostomic medications did not differ from those of patients who did not. Concentrations of some salivary gland components were altered in the HIV(+) group. Analysis of these data suggests that salivary gland function is adversely affected early in HIV infection and that these changes do not appear to be compounded by the taking of xerostomic medications.     

Editorial: Immunological tolerance: the good,the bad,and the ugly

The aim of this study was to explore the association between negative experiences during children's first dental visit and any subsequent dental anxiety and related factors in three dental clinics in the Veneto Region of Italy. For this purpose, parents of 378 children filled out a questionnaire. Factors related to child dental anxiety (none-some/fairly much-very much) were explored by means of logistic regression analysis. The independent variables were: problems with the first dental visit (no/yes), parental dental anxiety (none-some/fairly much-very much), number of previous visits (0-3/4 &;#104 ), site visited (public/private) and age of the child (<10 years/10 &;#104 years). Parental anxiety was associated with child's anxiety (OR = 2.3, 95% CI = 1.1-4.9). A problematic first visit was a strong predictor of dental anxiety. However, this effect was modified by the number of subsequent visits. Children with 4 or more visits after the first visit were less likely to be anxious after a problematic first visit (OR = 4.6, 95% CI = 1.5-14.1) than children with 3 visits or less after the first visit (OR = 19.8, 95% CI = 7.2-54.5). Thus, the negative effect of a problematic first visit may fade during subsequent dental visits.