Pattern of periodontal diseases in persons living with HIV infection/AIDS at the Kenyatta National Hospital Outpatient Center-Nairobi, Kenya
Background: The Human Immunodeficiency Virus (HIV) infection is considered a modifier of periodontal diseases with numerous studies reporting increased prevalence of various forms of periodontal diseases in Persons Living with HIV infection/ AIDS (PLWHA). Other studies have reported exacerbation of the pre-existing periodontal diseases with HIV induced immunosuppression. However, the pattern of periodontal diseases in PL WHA is not well documented especially in the Highly Active Antiretroviral Therapy (HAAR T) era. Objective: To describe the pattern of periodontal diseases among PL WHA. Study design: A hospital based descriptive cross-sectional study. Study area: The Comprehensive Care Centre (CCC) at Kenyatta National Hospital (KNH) - Nairobi, Kenya. Study population: Adult PL WHA whose status had been confirmed through serology test. Patients and methods: 284 participants whose HIV infection status had been confirmed through serological tests were screened with 186 meeting the inclusion criteria. Data on socio-demographic variables, past medical and dental histories were collected from the patients through a structured interview. The CD4 cell counts and HAART treatment profile were obtained from the patients' register. Oral hygiene status and periodontal status were recorded in a modified World Health Organization (WHO) clinical examination form 1997 (Appendix II). The modified Quigley and Hein index (Turesky et al. 1970) and the gingival index (Loe and Silness 1963) were used to assess the oral hygiene status and gingival inflammation respectively. Periodontitis was assessed using periodontal probing depth (PPD), recession and clinical attachment loss (CAL). Results: 186 participants were recruited into the study among whom 73 (39.2%) were males and 113 (60.8%) were females. The age ranged between 20 to ~5 years with a mean age of 40.25 ﾱ 9.73 years. The prevalence of periodontal diseases associated with HIV infection was 6.5% with 3.2% having Linear Gingival Erythema (LGE), while 1.1 % and 2.2% having Necrotizing Ulcerative Gingivitis (NUG) and Necrotizing Ulcerative Periodontitis (NUP) respectively. All the participants with NUG and NUP had <200 cells/mm3 CD4 cell counts while LGE was reported in participants with either 3 3 <200cells/mm or <500 cells/mm CD4 counts. The prevalence of conventional periodontitis in the current study was 62.9% with 4.3% having severe periodontitis, 25.3% with moderate periodontitis and 33.3% with mild periodontitis. The presence of periodontitis was significantly associated with low CD4 cell counts, however, the severity of periodontitis showed no significant association with CD4 cell counts. The CD4 cell counts of the study population ranged between 10 - 1309 cells/mm3 with a mean of 435ﾱ 250.99 cells/ mm''. Thirty four (18.3%) had CD4 cell counts of <200 cells/mm3 while the rest had >200 cells/mm3. Only thirty two (17.2%) participants were not on HAART. The mean plaque score was 1.78ﾱ0.49 while the mean gingival inflammation score was 1.34ﾱ0.38. An association between CD4 cell counts and the mean gingival inflammation score was observed, with participants who had 2: 200- 499 cells/rum' CD4 cell counts recording a higher mean gingival inflammation score than the rest. Conclusion: The prevalence of periodontal diseases was high among PL WHA with conventional periodontitis being the most prevalent. The presence of periodontal diseases was associated with low CD4 cell counts ﾫ200 cells/mm\ however, the severity of periodontitis showed no association with CD4 cell counts. Recommendation: Periodontal care should be incorporated as a component of comprehensive care for PL WHA.