Risk Factors for Periodontal Disease in an HIV-1 Cohort

Objective: To determine the characteristics of periodontal disease(PD) in an HIV-1 cohort during the era of highly active antiretroviral therapy(HAART). Methods: Subjects were recruited from 3 HIV clinics in Cleveland (n=111). Data were collected on HIV+ patients with at least 20 teeth and no evidence of diabetes or heart disease. Full-mouth periodontal exams determined periodontal probing depth(PPD), gingival recession(REC) and clinical attachment level(CAL) at six sites per tooth. Subgingival plaque samples were collected from predetermined sites and pooled to determine P. gingivalis, T. forsythia and T. denticola levels by RT-PCR. Fasting lipids and hsCRP were measured by standard assays. Information on viral load, CD4+T-cell count and exposure to antiviral therapy was collected from a longitudinal data base. Spearman's correlations, independent t-tests and multiple linear regression were used to determine significant relationships between independent predictors and periodontal outcome measures. Results: Participants were 41(±9) y/o, predominantly black (65%), male (74%) and Medicaid/government insured (74%); most were current smokers (55%). Mean CD4+T-cell count was 456 cells/mm3(±287); 20% of patients had CD4+ cell count <200. Most subjects (55%) had >30% of teeth with at least one PPD of >5.0 mm; 71% had >30% of teeth with REC <0 mm; and 67.4% had >30% of teeth with CAL >4 mm. Pg level was significantly correlated with all periodontal measures (rho=.242 to .417; p<.02). Regression analysis revealed that higher Pg levels (p=.001), CD4+ cells < 200 (p=.002), older age (p=.01) and lower LDL (p=.036) were significantly associated with greater CAL, after adjustment for patient characteristics, smoking, dental attendance and time on HAART (model adjusted R2=.417). Conclusion: Lowered CD4 cell count remains a major risk factor for PD. Even in those with immune reconstitution, periodontal health is suboptimal. Earlier detection and more aggressive treatment of PD is clearly indicated in this and similar populations. Supported by NIDCR-K23-DE-015746-04.