Improved Periodontal Disease in HIV+ Adults Experiencing Immune Reconstitution

Objective: The contribution of HIV-infection to periodontal disease (PD) is poorly understood.  We proposed that in HIV-infected adults who had recently started highly active antiretroviral therapy (HAART), improved CD4+ T cell count and/or plasma HIV RNA would be associated with improved PD.

Method: We performed a longitudinal cohort study of HIV-infected adults on HAART. PD was characterized clinically and microbiologically.  Immunological markers were collected within 4 months of PD measurement.  Linear mixed-effects models jointly assessed cross-sectional and longitudinal associations between immune function and PD.

Result: Forty (40) subjects completed a median of 3 visits (range 2-6). Over an estimated 24 months, periodontal probing depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP) improved by 12.6% (p<0.001), 13.1% (p<0.001) and 15.7% (p<0.001) of teeth exceeding cut points, respectively; meanwhile, mean CD4+ T-cell count increased significantly (187.2 cell/µl; p<0.001) and mean HIV RNA decreased significantly (0.6 log₁₀ copies/µl; p< 0.001). There was no evidence of a cross-sectional or longitudinal association between CD4+ T-cell count or HIV RNA and PPD, recession or BOP, however, there was a significant cross-sectional association between baseline CD4+ T-cell count and the baseline percentage of teeth with CAL ≥ 4 mm (p<0.01) after adjusting for age, smoking and Treponema denticola.  Significant cross-sectional and longitudinal associations were found between Poryphromonas gingivalis (Pg) level and the percentage of teeth with PPD ≥ 5 mm after adjusting for age, smoking, and HIV RNA (p<0.01 for both associations).

Conclusion: In a cohort of HIV-infected adults on HAART experiencing immune reconstitution, Pg level was significantly associated with clinical markers of PD. Traditional markers of immune function were not associated longitudinally with clinical markers of PD. Other markers of innate and/or adaptive immunity may link HIV to PD.