Most common oral manifestations in pediatric patients HIV positive and the effect of highly active antiretroviral therapy

Araújo, Joyce Figueira de; Oliveira, Ana Emília Figueiredo de; Carvalho, Halinna Larissa Cruz Correia de; Roma, Fábia Regina Vieira de Oliveira; Lopes, Fernanda Ferreira

doi:10.1590/1413-81232018231.19072015

Joyce Figueira de Araújo

Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil. joycefa1@hotmail.com

Ana Emília Figueiredo de Oliveira

Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil. joycefa1@hotmail.com

Halinna Larissa Cruz Correia de Carvalho

Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil. joycefa1@hotmail.com

Fábia Regina Vieira de Oliveira Roma

Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil. joycefa1@hotmail.com

Fernanda Ferreira Lopes

Departamento de Odontologia II, Centro de Ciências da Saúde, Universidade Federal do Maranhão. Av. Portugueses s/n, Bacangá. 65000-000 São Luís MA Brasil. joycefa1@hotmail.com

Collaborations

JF Araújo worked on the conception, design, research, analysis and interpretation of data and writing of the article; FRVO Roma worked on the analysis and interpretation of data and writing of the article; HLCC Carvalho worked on the design and writing of the article; AEF Oliveira and FF Lopes worked on the critical review and approval of the version to be published.

Author/Year	Methods	Purpose	Results	Conclusions
Vaseliu et al. 2005	Longitudinal study	To evaluate the presence of oral manifestations associated with HIV infection in children.	Most common oral lesions: gingivitis (49%), enlargement of the parotid glands (13%), oral candidiasis (11%), hairy leukoplakia (3%), herpes simplex (2%).	Gingivitis was the most prevalent lesion. Oral candidiasis and hairy leukoplakia were positive predictors for progression of the disease.
Glick 2005	Literature review	To discuss over the classification, prevalence and treatment of oral manifestations in HIV-positive children.	Oral lesions serve as markers for the deterioration of the immune system and progression of HIV.	The prevalence differs between regions. Three common orofacial lesions in children: oral candidiasis, enlargement of the parotid glands and lymphadenopathy. There is a significant association between the occurrence of oral lesions and immune suppression.
Miziara et al. 2006	Retrospective cohort study	To assess whether HAART changes the patterns and prevalence of oral lesions in HIV-positive children.	Lesions commonly associated with HIV: oral candidiasis, herpes simplex, linear gingival erythema, parotid enlargement, recurrent oral ulcerations.	Oral candidiasis was the most prevalent lesion. HAART use may be associated with a lower prevalence of oral lesions (especially oral hairy leukoplakia) compared to the use of ART.
Miziara e Weber 2008	Cross-sectional study	To assess the accuracy of oral lesions related to HIV to predict the immunologic and virologic failure in HIV-infected children on HAART.	31.6% of children had oral lesions.	Oral manifestations of HIV may be important markers for immunological suppression and for virological failure in Brazilian children on HAART.
Leao et al 2009	Literature review	To discuss the oral manifestations associated with HIV infection in adults and children, and, in addition, current trends of antiretroviral therapy and its effect on those lesions.	Most prevalent lesions: oral candidiasis, enlargement of the parotid glands and angular cheilitis.	Pseudomembranous candidiasis was considered to be the most common oral manifestation, often associated with the disease progression.

Autor/Ano	Methods	Purpose	Results	Conclusions
Sowole et al. 2009	Cross-sectional study	To assess oral manifestations, oral health status and treatment needs of pediatric patients with HIV.	Most common oral lesion was oral candidiasis (27%). 25.5% presented gingivitis and 3.6% presented enlargement of the parotid glands.	Candidiasis was the most common manifestation and could be used as a marker for early detection of HIV in children.
Pinheiro et al. 2009	Literature review	To review current epidemiological trends of oral manifestations in HIV-positive children on HAART.	Most common lesion: oral candidiasis. HAART use decreased the severity and/or frequency of the lesions. Observe the Immune reconstitution inflammatory syndrome (IRIS) because some unusual manifestations may occur after the use of HAART.	HAART typically reduces the frequency and/or severity of most oral lesions associated with HIV infection, but SRI is resurfacing and modifying the injury presented.
Gaitán-Cepeda et al. 2010	Cross-sectional study	To assess the prevalence of HIV-related oral lesions in HIV-positive adolescents and the differences between them and HIV-positive children infected in the perinatal period.	Oral candidiasis was the most prevalent oral lesion in both groups. There is association (p <0.05) between a high prevalence of HIV and oral candidiasis with a high viral load.	Adolescents infected with HIV in the perinatal period have a high prevalence of HIV-related oral lesions, oral candidiasis being the most frequent lesion in both groups.
Ranganathan et al. 2010	Cross-sectional study	To document and study the most common oral lesions in HIV-positive children and its connection to diseases in other parts of the body.	62.2% had oral lesions. Most frequent lesions: oral candidiasis (56.1%) and gingivitis (10.8%). Most common systemic lesion: lymphadenopathy (74.1%). Enlargement of the parotid glands was observerd in 36.8% of the children.	Oral and systemic lesions were significant characteristics in HIV-positive children. Oral candidiasis was the most common lesion associated with the degree of immunosuppression.
Domaneschi et al. 2011	Cross-sectional study	To assess the prevalence of factors associated with the colonization of Candida albicans in pediatric AIDS patients.	Prevalence of 62% candida colonization in patients with HIV. Inverse association between colonization by Candida and the use of antiretrovirals.	Despite the high evidence of colonization by candida, manifestations in oral candidiasis were reduced, probably due to the use of antiretroviral drugs.

Author/Year	Methods	Purpose	Results	Conclusions
Ogunbosi et al. 2011	Cross-sectional study	To estimate the prevalence, clinical pattern of HIV infection and the results amongst new patients aged <15 years, using age-specific diagnostic methods.	A significant proportion (p = 0,000) of HIV-infected children presented oral candidiasis (13.3%). In the logistic regression analysis, candidiasis was considered a predictive characteristic of HIV (OR = 0,223; p = 0,026).	The prevalence rate of HIV infection in patients submitted to the PITC test was high
Rosendo et al. 2011	Longitudinal study	To assess oral conditions in HIV-positive children.	The frequency of oral lesions was 61.6%. Gingivitis was the most prevalent with 57.5%, followed by oral candidiasis with 19.1% and primary herpetic gingivostomatitis with 17%.	Oral manifestations are very common in children affected by the HIV virus, and gingivitis is the most prevalent oral manifestation.
Ponnam et al. 2012	Cross-sectional study	To adentify the oral manifestations in HIV-positive children on HAART.	Children on HAART had fewer oral manifestations than those who did not receive the therapy. Gingivitis and oral candidiasis were the most common lesions in patients on HAART.	HAART use increased the disease-free status in HIV-positive children, which increases the life span. Oral candidiasis and ulcerative stomatitis were significantly less prevalent in children on HAART.
Sales-Peres et al. 2012	Cross-sectional study	To assess oral manifestations in HIV-infected children on or not on ART.	Total lesions in the buccal mucosa: 13.3%. Enlargement of the parotid glands was seen in 23% of patients. Oral lesions observed: oral candidiasis, gingivitis and herpetic stomatitis. Children who were not on ART were more affected by oral lesions.	Patients on ART are less likely to have lesions on the oral mucosa. The most frequent oral lesion was candidiasis (5.5%).

Author/Year	Methods	Purpose	Results	Conclusions
Kumar et al. 2013	Cross-sectional study	To assess the prevalence rate of oral lesions in HIV infected children treated in antiretroviral therapy clinics.	The most frequent oral lesions were oral candidiasis (20.86%), angular cheilitis (16.56%), necrotizing ulcerative gingivitis (8.28%), linear gingival erythema (5.53%) and aphthous ulcers (2.76 %).	61.65% had oral lesions, and the age group of 9-12 years was the most affected (28.53%). Oral candidiasis was the most prevalent lesion (20.86%).
Tonelli et al. 2013	Systematic reviews	To investigate the main oral manifestations in pediatric patients infected with HIV.	Average prevalence of oral manifestations in children: 63%. Main lesions found in the articles: oral candidiasis, angular cheilitis, linear gingival erythema, xerostomia, enlargement of the parotid glands, Kaposi's sarcoma, herpes simplex, recurrent aphthous ulcers (RAUs).	Oral lesions are common in pediatric patients infected with HIV. Most common lesion: oral candidiasis, with a prevalence of up to 90%, being an important marker of immune compromise. Linear gingival erythema has been found with a prevalence of 27%.
Konstantyner et al. 2013	Retrospective cohort study	To verify the factors associated with time spent free of oral candidiasis in children living with HIV, using the technique of survival analysis for recurrent events.	Associated factors: mono, double or triple therapy with HAART, immunosuppression, hospitalization and malnutrition lead to more time without oral candidiasis in children with HIV.	HAART has a beneficial effect in the prevention of oral candidiasis. Other factors are associated with the reduction of the prevalence of this oral manifestation.
Jose et al. 2013	Cross-sectional study	To evaluate the prevalence of oral manifestations in HIV patients receiving on or not on HAART.	Candidiasis was the most frequent oral manifestation in both groups, on or not on HAART (33% in total), followed by linear gingival erythema with 16%. Patients with HIV on HAART present moderate oral manifestations.	Oral candidiasis was the most frequent lesion. Lymphadenopathy was the most prevalent systemic condition (85%). HAART decreased the rate of oral manifestations. Only recurrent aphthous ulcerations (RAU) were greater in patients with HAART.
Meless et al. 2014	Cross-sectional study	To estimate the prevalence of oral mucosal diseases and dental caries in children with HIV on ART.	Lesions of the oral mucosa were rare in children with HIV on ART, occurring in only 8.3% of them. The most frequent lesion was oral candidiasis (24 lesions of 42 found).	Enlargement of the parotid glands seems to be common even on ART (16.4%). The most frequent lesion was oral candidiasis (52.6%).

[1] Collaborations

JF Araújo worked on the conception, design, research, analysis and interpretation of data and writing of the article; FRVO Roma worked on the analysis and interpretation of data and writing of the article; HLCC Carvalho worked on the design and writing of the article; AEF Oliveira and FF Lopes worked on the critical review and approval of the version to be published.

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Most common oral manifestations in pediatric patients HIV positive and the effect of highly active antiretroviral therapy

Abstract