Neurocognitive Impairment and Oral Health Outcomes in Patients with HIV (PWH) On Antiretroviral Therapy (ART)

Abstract

Background The advent of antiretroviral medication (ART) led to a significant decline in HIV associated morbidity, including the more severe presentations of HIV-associated neurocognitive disorders (HAND). However, milder forms of neurocognitive impairment (NCI) persist. Neurocognitive deficits have also been independently associated with poor dental outcomes, especially in the elderly population. However, there is limited, if any, reports of dental health outcomes in people with HIV (PWH) with NCI. This study was designed to better understand oral health outcomes in PWH with NCI. Methods A cross-sectional pilot study was conducted on 40 participants, comprising 10 healthy controls and 30 PWH. Neurocognition and dental outcomes were assessed in all participants. Neurocognition was evaluated using a computerized neurobehavioral battery (CNB) test. Dental caries was assessed using the Decayed, Missing, and Filled Teeth (DMFT) index, the Decayed and Filled Teeth (DFT) index, and the Missing Teeth (MT) index. Periodontal status was measured through clinical attachment loss, periodontal pocket depth, and the percentage of sites with bleeding on probing (%BOP). Results Mean DMFT, DFT and MT were significantly higher among PWH (p < 0.001, p = 0.02, p = 0.048, respectively) than in control subjects. NCI was present in 4 PWH and 1 control subject. We also noted that among PWH, those with NCI had a higher DMFT index (20.8 versus 18.5) and a significantly higher mean DFT (12.3 versus 8.0) compared to PWH without NCI (p = 0.048).

Conclusion Poor oral health, especially dental caries, is a challenge among PWH and moreso among PWH with NCI.