NIDCR/CDC
Dental, Oral and Craniofacial
Data Resource Center

Oral Health, U.S. 2002 Annual Report

Section 15: LINKS TO SYSTEMIC HEALTH/ MANIFESTATIONS OF SYSTEMIC DISEASE

The human immunodeficiency virus (HIV) is a viral infection that gradually destroys the immune system. Primary or acute HIV infection may be associated with symptoms resembling mononucleosis or influenza. HIV seroconversion usually occurs within 3 months of exposure. Acute HIV infection can, but does not always, progress to symptomatic HIV infection and advanced HIV diseases or acquired immunodeficiency syndrome (AIDS). It cannot be assumed that all people infected with HIV will inevitably progress to AIDS. It is estimated that 1 out of every 200 people in the United States carries the HIV virus, but not all of them are symptomatic (http://webmd.lycos.com/content/ asset/adam_disease_hiv_infection).

The prevalence of AIDS in the United States has been increasing, although the rate of increase has slowed (CDC, 2000). This increase is in part due to increased survival time resulting from new drug therapies and better medical management. It extends across all groups, inclusive of race, gender, age, and geographic location. Approximately 320,000 persons were living with AIDS at the end of 1999.

Rates of HIV transmission and disease among African Americans are disproportionately high and not declining as rapidly in response to effective interventions as they are among whites (Smith et al., 2000). A number of factors have been suggested for this disparity, including increased rates of participation in high-risk sexual and drug use behaviors (Aral et al., 1996; Rothenberg, 1996; Shiboski & Padian, 1996; Smith et al., 2000).

The oral manifestations of HIV/AIDS include oral candidiasis, which is frequently observed in the earliest stages of HIV infection. It affects more than 30% of HIV-positive individuals and is seen in more than 90% of AIDS patients (US DHHS, 2000; Patton et al., 1999). Other oral lesions seen among AIDS patients include linear gingival erythema, necrotizing ulcerative periodontitis, stomatitis, gingivitis, oral hairy leukoplakia, herpes simplex virus infection, cytomegalovirus ulceration, human papillomavirus infection, recurrent aphthous ulcers, and HIV salivary gland disease (US DHHS, 2000; Patton et al., 1999; Phelan et al., 1997).

SOURCE OF DATA
The analyses reported here are derived from Shiboski CH, Hilton JF, Neuhaus JM, et al. Human immunodeficiency virus-related oral manifestations and gender. A longitudinal analysis. The University of California, San Francisco Oral AIDS Center Epidemiology Collaborative Group. Arch Intern Med 1996;156(19):2249-54. Nationally representative data are not available. The study population included HIV-positive men and women in California. The results are part of a 4-year prospective study between 1987 and 1991. A standardized oral examination was administered at baseline and every 6 months thereafter.

• Oral manifestations of HIV/AIDS
• Men had a higher prevalence of oral lesions than women.
• The most common type of oral lesion was oral candidiasis.

REFERENCES
Aral SO, Holmes KK, Padian, NS, Cates W. Overview: individual and population approaches to the epidemiology and prevention of sexually transmitted diseases and human immunodeficiency virus infection. J Infect Dis 1996;174 (Suppl 2): S127–S133.

Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2000;12(1):3–4.

Patton LL, van der Host C. Oral infections and other manifestations of HIV disease. Oral Infection 1999;13:879–900.

Phelan JA. Dental lesions: diagnosis and treatment. Oral Dis 1997;3:5235–5237.

Rothenberg RB. Personal risk taking and the spread of disease: beyond core groups. J Infect Dis 1996;174(Suppl 2): S144–S149.

Shiboski CH, Hilton JF, Neuhaus JM, et al. Human immunodeficiency virus-related oral manifestations and gender. A longitudinal analysis. The University of California, San Francisco Oral AIDS Center Epidemiology Collaborative Group. Arch Intern Med 1996;156(19):2249–2254.

Shiboski S, Padian N. Population- and individual-based approaches to the design and analysis of epidemiologic studies of sexually transmitted disease transmission. J Infect Dis 1996;174(Suppl 2):S188–S200.

Smith DK, Gwinn M, Selik RM, et al. HIV/AIDS among African-Americans: progress or progression? AIDS 2000;14:1237–12348.

U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

Table 15.3.1. Frequency of oral lesions by gender

*These percentages represent the total number of first lesions diagnosed divided by the total number of participants.

Source: Shiboski CH, Hilton JF, Neuhaus JM, et al. Human immunodeficiency virus-related oral manifestations and gender. A longitudinal analysis. The University of California, San Francisco Oral AIDS Center Epidemiology Collaborative Group. Arch Intern Med. 1996 Oct 28;156(19):2249–2254. Copyrighted 1996, American Medical Association.

Department of Health and Human Services
National Institute of Dental And Craniofacial Research (NIDCR)	CDC Division of Oral Health
National Institutes of Health

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