The prevalence of Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome (HIV / AIDS) in the world continues to increase, not least in Indonesia. 48,000 HIV cases and 38,000 AIDS cases were found in Indonesia in 2016. The prevalence of HIV / AIDS sufferers in Indonesia is 620,000, including 14% of pregnant women with HIV / AIDS infection who are receiving antiretroviral (ARV) therapy as prophylaxis for reducing transmission of HIV / AIDS transmission to their children.
It is estimated that around 3200 (2500-4000) children are infected with HIV due to Mother-To-Child Transmission (MTCT) in Indonesia. In 2017, HIV / AIDS transmission through MTCT declined in the Asia Pacific region but was still relatively high at around 17 percent.
Pregnant women with HIV / AIDS infection are estimated to be around 56 percent of 61,000. They gave birth in the Asia Pacific region that received effective ARV prophylaxis, only 25 percent of children with HIV / AIDS were diagnosed early. Children with perinatal HIV / AIDS infections have increased by 230 percent since 2010.
The prevalence of caries in children suffering from HIV / AIDS is increasing from year to year. Dental caries is still a problem of oral health and burden throughout the world, especially in Indonesia. An earlier report conducted by the Republic of Indonesia, the Ministry of Health in Basic Health Research Report or Basic Health Research (RISKESDAS) stated that Indonesia national DMFT index was high at 4.6 without an insignificant increase since 2007.
A World Health Organization (WHO) study among 190 countries showed that the prevalence of dental caries in Indonesia is the highest worldwide with an average of around 2.1. Indonesia has become the country with the highest prevalence of dental caries in the Southeast Asian Region.
During infection and the development of HIV / AIDS, there is a disruption of the immune system. AIDS occurs in all parts of the body during the development of HIV without exception [13]. A Cluster of Differentiation 4 (CD4 +) on the surface of lymphocytes is an excellent marker for detecting the immunosuppressed status of people with HIV / AIDS (PLWHA). Significantly decreased CD4 + counts result in errors in homeostasis and immune mechanisms against microorganisms. Mucosal immunity as a defense against the oral cavity is weak in PLWHA, which can cause an increase in normal flora colonies in the oral cavity [14-16].
Streptococcus mutans is a commensal bacterium in the oral cavity and known as the etiology of dental caries. During the development of HIV / AIDS, S. mutans colonies increased significantly. Teeth and oral cavity are an integral part of the digestive tract, which is important for digestion and nutrient intake in PLWHA. Dental caries and oral manifestations that occur in HIV / AIDS interfere with a nutrient intake which can cause nutritional deficiencies, which makes the immunosuppression condition worsen.
The prevalence of dental caries can be assessed using decayed-missing-filling (dmft) or DMFT. The DMFT / DMFT index is the easiest, simplest, reliable, valid, commonly used for oral health assessment. This study hypothesized a high prevalence of dental caries in children with HIV / AIDS infection due to low CD4 cell counts.
There have been no studies on the correlation of CD4 + counts with high caries prevalence in children with HIV / AIDS infection in Surabaya, Indonesia. Thus, the main objective of this study was to investigate the correlation of CD4 + counts with the high prevalence of dental caries in CLPWHA treated at Tertiary General Hospital, Surabaya, Indonesia.
This research is an analytic observational study with a cross-sectional design. The total sample random method is used. Twenty-nine HIV positive perinatal children aged 1-12 years old were recruited from the inpatient unit of the Intermediate Care and Infectious Diseases Unit (UPIPI) Dr. Soetomo Hospital Surabaya.
The results showed that the prevalence of caries in children suffering from HIV / AIDS was very high at 86.2 percent with dmft / DMFT caries index 8.2 / 6.3. There is a significant correlation between the low CD4 + count and the high prevalence of caries.
For the first time, the prevalence of dental caries from CLWPHA in Surabaya, Indonesia, children with HIV / AIDS infection are known and interestingly, low CD4 + counts correlate with high dental caries prevalence in CLWPHA. In addition, further investigation is needed with better arrangements and a wider area. (*)
Author: Diah Savitri Ernawati
Detaill of research can be viewed here:
http://revista.uepb.edu.br/index.php/pboci/article/view/4819/pdf
This post can be cited in the following information,
Nugraha AP, Mensana MP, Soebadi B, Husada D, Triyono EA, Prasetyo RA, Ernawati DS. Correlation of Low CD4+ Counts with High Dental Caries Prevalence in Children Living with Perinatal HIV/AIDS Undergoing Antiretroviral Therapy. Pesquisa Brasileira em Odontopediatria Clínica Integrada 2019; 19:e4819. DOI: http://doi.org/10.4034/PBOCI.2019.191.119.
