Effects of ART on the Oral Health of HIV-Infected Children and Adolescents in Kenya

Thesis (Master's)--University of Washington, 2021Purpose: To determine the prevalence of HIV oral manifestations and oral comorbidities in ART treated children and adolescents, and its relationship with oral health status at the time initiation of ART. Methods: We utilized convenience sampling of a population nested into ongoing cohort studies of 78 Kenyan HIV-infected children who were enrolled and initiated antiretroviral therapy (ART) as part of two clinical trials. Oral health examinations were performed by Community Oral Health Officers (COHO’s) to determine oral health endpoints. Demographics, age at initiation of ART, HIV diagnosis, baseline CD4, and HIV RNA viral load data were extracted from the primary study databases. Fisher’s exact and two-sample t-tests were run to examine the significance of the differences observed between early and late ART initiation groups. Results: The majority of children and adolescents evaluated in this study were found to have at least one type of oral disease (83.3%). When compared to children with early art initiation, children with late art initiation showed decreased odds of having dental caries (OR:0.55 CI:0.20, 1.48; p=0.23), decreased odds of presenting with any HIV-associated oral lesion when compared to early ART initiation (OR: 0.57; CI:0.18, 1.62; p= 0.31) and the mean dmft/DMFT (adjusted model; Ã :-1.23; CI:-7.7, 4.90; p=0.69). Conclusion: Oral disease is highly prevalent in Kenyan CALHIV despite having access to high quality medical care at the Kenyatta National Hospital. Oral disease prevalence varies by age at initiation of ART and should be investigated further on an individual basis. This study highlights the opportunity for integrating oral health in pediatric HIV medical, boosting interprofessional collaboration in the effort to improve the quality of life of CALHIV