Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
- Dental caries
- Oral hygiene and periodontal health status
- HIV-related orofacial diseases based on WHO clinical staging and immunological classification, including:
- Stage 2 (angular cheilitis, herpes zoster, linear gingival erythema, recurrent oral ulcerations, parotid enlargement
- Stage 3 (oral candidiasis, oral hairy leukoplakia, acute necrotizing ulcerative gingivitis/periodontitis)
- Stage 4 (Herpes simplex infection, Kaposi sarcoma)
- Saliva immunoglobulins quantity
- Oral candidiasis
- Dental development
2.1. Search Strategies
2.2. Study Selection
2.3. Data Extraction and Management
2.4. Subgroup Analyses
2.5. Risk of Bias (RoB) Assessment
2.6. Data Synthesis
2.7. Assessment of Heterogeneity
2.8. Assessment of Publication Bias
2.9. Assessment of Quality of Evidence
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. RoB
3.4. Dental Caries Experience
3.5. Oral Hygiene and Periodontal Status
3.6. HIV-Related Orofacial Diseases
3.7. Saliva Immunoglobulins Quantity
3.8. Oral Candidiasis
3.9. Dental Development
3.10. Other Associated Factors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Search Strategies
PubMed Searched on 29 July 2022 Results: 256 (((((HIV Infections[MeSH] OR HIV[MeSH] OR “sexually transmitted diseases, viral”[MeSH] OR AIDS[MeSH] OR HIV[tw] OR HIV-1[tw] OR HIV-2[tw] OR HIV1[tw] OR HIV2[tw] OR HIVinfect*[tw] OR human immunodeficiency virus[tw] OR human immune-deficiency virus[tw] OR human immuno-deficiency virus[tw] OR human immune-deficiency virus[tw] OR ((human immun*) AND (deficiency virus[tw])) OR acquired immunodeficiency syndrome[tw] OR acquired immune-deficiency syndrome[tw] OR acquired immuno-deficiency syndrome[tw] OR acquired immune-deficiency syndrome[tw] OR ((acquired immun*) AND (deficiency syndrome[tw]))))) AND ((“Adolescent”[Mesh] OR “Child”[Mesh] OR “Infant”[Mesh] OR “pediatric”[tw] OR ”paediatric”[tw] OR “adolescent”[tw] OR “teen”[tw] OR “infant”[tw]))) AND (((((((((((("Oral Health"[MeSH]) OR "Mouth Diseases"[MeSH]) OR “Oral Hygiene”[MeSH]) OR “Dental Caries”[MeSH]) OR “Periodontal Diseases”[MeSH]) OR "Gingival Diseases"[MeSH]) OR "Tooth Injuries"[MeSH]) OR "Mouth Neoplasms”[MeSH]) OR “Dentistry”[MeSH])) OR ((((((((((((oral health[tw]) OR mouth disease*[tw]) OR oral hygiene[tw]) OR mouth hygiene[tw]) OR dental caries[tw]) OR periodontal disease*[tw]) OR gingival disease*[tw]) OR tooth injur*[tw]) OR mouth tumor[tw]) OR oral cancer[tw]) OR dentistry[tw]))))) AND (((“Antiretroviral Therapy, Highly Active”[Mesh] OR “Anti-Retroviral Agents"[Mesh] OR “antiretroviral”[tw] OR “ART”[tw] OR “medication”[tw]))) |
Medline (Ovid MEDLINE(R) 1946 to December Week 4 2019, Ovid MEDLINE(R) In-Process and Other Non-Indexed Citations 26 July 2019) Searched on 29 July 2022 Results: 243
|
Embase (Embase Classic+Embase 1947 to 2018 December 28) Searched on 29 July 2022 Results: 610
|
Scopus Searched on 29 Jul 2022 Results: 199 (((TITLE-ABS-KEY (“HIV Infections” OR HIVOR “sexually transmitted diseases, viral” OR Aids OR “HIV-1” OR “HIV-2” OR HIV1 OR HIV2 OR “human immunodeficiency virus” OR “human immune-deficiency virus” OR "human immuno-deficiency virus” OR “human immune-deficiency virus”) OR TITLE-ABS-KEY (“acquired immunodeficiency syndrome” OR “acquired immune-deficiency syndrome” OR “acquired immuno-deficiency syndrome” OR “acquired immune-deficiency syndrome”))) AND (TITLE-ABS-KEY (adolescent OR child OR infant OR pediatric OR paediatric OR teen)) AND ( TITLE-ABS-KEY (“oral health” OR “Mouth Diseases” OR “Oral Hygiene” OR “Dental Caries” OR “Periodontal Diseases” OR “Gingival Diseases” OR “Tooth Injuries” OR “Mouth Neoplasms” OR “mouth tumor” OR “oral cancer” OR dentistry))) AND (TITLE-ABS-KEY (“Antiretroviral Therapy, Highly Active” OR “Anti-Retroviral Agents” OR antiretroviral OR art OR medication)) |
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Study (Year, Country †) P/R | Number of Subjects (% Males) | Age Range (Year) | Recruitment | Inclusion (I) /Exclusion (E) Criteria ‡ | Confounders Evaluated | Outcome Measures | ||
---|---|---|---|---|---|---|---|---|
1 | Baghirath [22] (2013; IND) P | HIV+ve ART | 50 (46) | 5–12 | Nireekshana ART centre, Hyderabad (NGO) | (I) Seropositive for antibody to HIV when tested by a particle agglutination test for antibodies to HIV and enzyme-linked immunosorbent assay (ELISA) (E) HIV-infected subjects with a history of local radiation therapy to the head and neck region. |
|
|
HIV+ve ART | 50 (50) | 5–12 | Nearby school | (I) Systemically healthy subjects (children with a negative history of anaemia, oral ulceration, herpetic lesions, etc.) | ||||
2 | Bosco [23] (2002, BRA) P | HIV+ve ART | 30 (NR) | 2–6 | Pediatric Infectology Center | (I) Born from HIV-positive mothers, presenting with anti-HIV serum, positively detected by means of ELISA and Western Blot tests after 15 months of age (I) Examined for CD4+ counts once, two to three months before clinical examination (I) Symptomatic children with AIDS, under constant and regular treatment with drugs |
|
|
HIV-ve | 30 (NR) | 2–6 | ||||||
3 | Bosco [24] (2003, BRA) P | HIV+ve ART | 30 (NR) | 2–6 | Pediatric Infectology Center | (I) Born from HIV-positive mothers, presenting with anti-HIV serum, positively detected by means of ELISA and Western Blot tests after 15 months of age. (I) Examined for CD4+ counts once, two to three months before clinical examination. (I) Symptomatic children with AIDS, under constant and regular treatment with drugs |
|
|
HIV-ve | 30 (NR) | 2–6 | ||||||
4 | Cerqueira [25] (2010; BRA) P | HIV+ve HAART | 65 (41.5) | 2–13 | Pediatric AIDS Outpatients Clinic at the Federal University | (I) Definitive diagnosis for HIV infection confirmed by 2 positive ELISA tests and 1 positive Western Blot (E) Presence of fixed or removable orthodontic appliances and systemic or local antifungal treatment within the last three months |
|
|
HIV-ve | 40 (50) | 5–18 | Age and gender-matched siblings | (I) HIV-seronegative children confirmed by the aforementioned tests (E) Presence of fixed or removable orthodontic appliances and systemic or local antifungal treatment within the last three months | ||||
5 | de Souza [26] (2015, BRA) P | HIV+ve HAART | 80 (40) | 4–15 | University stomatology department | (I) Vertically infected children, with known gender; date of birth; and date of image acquisition |
|
|
HIV-ve | 80 (40) | 4–15 | ||||||
6 | Divakar [27] (2015; SAU) P | HIV+ve ART | 62 (59.6) | 5–15 | District Hospital ART centre | (I) Positive on particle agglutination test for antibodies to HIV and enzyme-inked immunosorbent assay (ELISA) (E) History of adverse habits like tobacco, betel nut |
|
|
HIV-ve | 62 (58.1) | 5–15 | Nearby school | (I) Systemically healthy subjects (E) History of adverse habits like tobacco, betel nut | ||||
7 | Fernandes [28] (2007; BRA)P | HIV-ve | 50 (48) | 4–13 | Hospital Pediatric AIDS Service | (E) Less than four years old because of the difficulty in obtaining a panoramic radiograph (E) Infected with HIV and hospitalized because of their debilitated physical condition (E) Presented with systemic illnesses were excluded from the control group. |
|
|
HIV+ve ART | 30(56.7) | 5–16 | Pediatric Dentistry and Clinic for Children and Adolescents | |||||
8 | Holderbaum [29] (2005, BRA) P | HIV+ve ART | 30(56.7) | 5–16 | University Pediatric Service of the Clinical Hospital | (I) Vertically infected and were under outpatient treatment |
|
|
HIV-ve | 30 (56.7) | 5–16 | University School of Dentistry | (I) Did not present any other systemic condition (I) Presented chronological ages similar to those of the HIV-positive children in both phases | ||||
9 | Pomarico [30] (2009; BRA) P | HIV+ve HAART | 65 (41.5) | 2–13 | Pediatric AIDS Outpatients Clinic at the Federal University | (I) Definitive diagnosis for HIV infection confirmed by 2 positive ELISA tests and 1 positive Western Blot (E) Presence of fixed or removable orthodontic appliances and systemic or local antifungal treatment within the last three months |
|
|
HIV-ve | 40 (50) | 5–18 | Age and gender-matched siblings | (I) HIV-seronegative children confirmed by the aforementioned tests (E) Presence of fixed or removable orthodontic appliances and systemic or local antifungal treatment within the last three months | ||||
10 | Ponnam [9] (2012, IND) P | HIV+ve HAART | 95 (45.3) | 5–15 | Anti-Retroviral Therapy (ART) Center in Government General Hospital |
|
| |
HIV-ve | 95 (NR) | 5–15 | Anti-Retroviral Therapy (ART) Center in Government General Hospital | (I) Same age group and same socioeconomic status | ||||
11 | Rajonson [31] (2016, CIV, MIL, SEN) P | HIV+ve HAART | 420 (53.1) | 5–15 | Five HIV pediatric clinics participating in International Epidemiologic Databases to evaluate AIDS (IeDEA) West Africa Consortium | (I) HIV-infected children on ART |
|
|
HIV-ve | 418 (52.9) | 5–15 | Age and gender-matched siblings | |||||
12 | Subramaniam [32] (2015; IND) P | HIV+ve Post-ART | 25 (58.5) | 6–8 | HIV centers | (I) HIV infected children aged 6–8 years (I) Children prior to onset of anti-retroviral therapy and Group 2 consisting of children undergoing anti-retroviral therapy for more than 3 years |
|
|
HIV-ve | 50 | 6–8 | Similar geographic surroundings |
Study (Year) | Number of Subjects | Outcomes | ||||||
---|---|---|---|---|---|---|---|---|
Exposure | Control | Exposure | Control | OR | 95% CI | |||
Dental caries prevalence and severity | ||||||||
1 | Ponnam (2012) [9] | HIV+ve HAART | HIV-ve | 95 | 95 | DMFT/dmft > 0 | 1.27 | (0.69, 2.35) NS |
2 | Rajonson (2017) [31] | HIV+ve ART | HIV-ve | 420 | 418 | DMFT/dmf t> 0 | 3.39 | (2.41, 4.76) * |
Overall | 2.70 | (2.01, 3.62) * | ||||||
Rajonson (2017) [31] | 407 | 317 | DMFT > 0 | 2.49 | (1.86, 3.32) * | |||
Rajonson (2017) [31] | 286 | 278 | dmft > 0 | 1.93 | (1.34, 2.79) * | |||
Oral hygiene and periodontal status | ||||||||
1 | Bosco (2002) [23] | HIV+ve ART | HIV-ve | 30 | 30 | Gingivitis/ periodontitis | 31.24 | (1.73, 563.16) * |
2 | Ponnam (2012) [9] | HIV+ve HAART | HIV-ve | 95 | 95 | 2.23 | (1.10, 4.52) * | |
Overall | 3.11 | (1.62, 5.97) * | ||||||
Rajonson (2017) [31] | HIV+ve HAART | HIV-ve | 419 | 418 | Poor oral hygiene (OHI-S > 3) | 1.23 | (0.73, 2.07) NS | |
Oral health-related WHO clinical staging 2 | ||||||||
1 | Baghirath (2013) [22] | HIV+ve ART | HIV-ve | 50 | 50 | Angular cheilitis † | 3.96 | (0.12 ,76.95) NS |
2 | Divarkar (2015) [27] | 62 | 62 | 1.00 | (0.02, 51.19) NS | |||
Overall | 1.95 | (0.16, 23.65) NS | ||||||
1 | Baghirath (2013) [22] | HIV+ve ART | HIV-ve | 50 | 50 | Linear gingival erythema † | 1.00 | (0.02, 51.38) NS |
2 | Divarkar (2015) [27] | 62 | 62 | 1.00 | (0.02, 51.19) NS | |||
Overall | 1.00 | (0.06, 16.19) NS | ||||||
1 | Baghirath (2013) [22] | HIV+ve ART | HIV-ve | 30 | 30 | Recurrent oral ulcerations † | 3.10 | (0.12, 79.23) NS |
2 | Divarkar (2015) [27] | 50 | 50 | 7.44 | (0.37, 147.92) NS | |||
3 | Bosco (2002) [23] | 62 | 62 | 11.96 | (0.65,221.05) NS | |||
Overall | 6.83 | (1.18, 39.53) * | ||||||
1 | Bosco (2002) [23] | HIV+ve ART | HIV-ve | 30 | 30 | Persistent parotid enlargement † | 10.36 | (0.53, 201.45) NS |
Oral-health related WHO clinical staging 3 | ||||||||
1 | Baghirath (2013) [22] | HIV+ve ART | HIV-ve | 50 | 50 | Oral candidiasis † | 17.41 | (0.97, 313.73) NS |
2 | Bosco (2002) [23] | 30 | 30 | 19.47 | (1.06, 358.38) * | |||
3 | Divarkar (2015) [27] | 62 | 62 | 27.91 | (1.61, 485.13) * | |||
4 | Pomarico (2009) [30] | 25 | 40 | 4.96 | (0.19, 126.59) NS | |||
5 | Pomarico (2009) [30] | HIV+ve HAART | HIV-ve | 25 | 40 | 8.68 | (0.40, 190.39) NS | |
6 | Ponnam (2012) [9] | 24 | 40 | 39.64 | (2.34, 671.20) * | |||
Overall | 16.94 | (5.06, 56.70) * | ||||||
1 | Baghirath (2013) [22] | HIV+ve ART | HIV-ve | 50 | 50 | Oral hairy leukoplakia † | 1.00 | (0.02, 51.38) NS |
2 | Divarkar (2015) [27] | 62 | 55 | 1.00 | (0.02, 51.19) NS | |||
Overall | 1.00 | (0.06, 16.19) NS | ||||||
1 | None | Acute necrotizing ulcerative gingivitis/periodonitits | ||||||
Oral health-related WHO clinical staging 4 | ||||||||
None | Chronic herpes simplex infection | (Nil) | (Nil) | |||||
None | Kaposi’s sarcoma | (Nil) | (Nil) | |||||
Other oral health-related diseases and conditions | ||||||||
1 | Baghirath (2013) [22] | HIV+ve ART | HIV-ve | 50 | 50 | Hyperpigmentation † | 45.59 | (2.70, 768.71) * |
2 | Divarkar (2015) [27] | HIV+ve ART | HIV-ve | 62 | 55 | 12.21 | (0.66, 226.97) NS | |
3 | Ponnan (2012) [9] | HIV+ve HAART | HIV-ve | 95 | 95 | 14.38 | (0.79, 261.05) NS | |
Overall | 20.35 | (3.86, 107.39) * | ||||||
1 | Ponnan (2012) [9] | HIV+ve HAART | HIV-ve | 95 | 95 | Mucocele † | 3.03 | (0.12, 75.37) NS |
1 | Ponnan (2012) [9] | HIV+ve HAART | HIV-ve | 95 | 95 | Ulcerative stomatitis † | 28.59 | (1.67, 490.32) * |
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Lam, P.P.Y.; Zhou, N.; Wong, H.M.; Yiu, C.K.Y. Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 12864. https://doi.org/10.3390/ijerph191912864
Lam PPY, Zhou N, Wong HM, Yiu CKY. Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022; 19(19):12864. https://doi.org/10.3390/ijerph191912864
Chicago/Turabian StyleLam, Phoebe Pui Ying, Ni Zhou, Hai Ming Wong, and Cynthia Kar Yung Yiu. 2022. "Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 19, no. 19: 12864. https://doi.org/10.3390/ijerph191912864