1. HIV/ AIDS Guadalupe Compean Diana Martinez Thu Ton

2. Etiology HIV (Human immunodeficiency virus) is a retrovirus that causes AIDS. It infects the T-cells of the immune system and results in an infection with a long incubation period averaging 10 years. AIDS is the late stage of HIV infection; a disease in which the immune system breaks down and is severely damaged and has difficulty fighting the disease. People who have AIDS are likely to develop serious infections such as “opportunistic infections.” People infected with HIV progresses to AIDS when their viral load increases and CD4 count fall below 200 or they experience an AIDS-defining complication. Before people with HIV could progress to AIDS in just a few years but currently, people can live much longer-even decades- with HIV before developing AIDs.

3. Occurrence & Population More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 6 people are unaware of their infection.

4. Modes of Transmission Infected through the blood -Blood transfusions -Sharing needles and accidental needle sticks Perinatal -Mother to child: travels through placenta -Breast milk Sexual contact -Semen or vaginal secretions -Multiple partners

5. Treatment Tests and diagnosis 1.CD4 count 2.Viral load 3.Drug resistance There is no cure for this disease but a combination of different drugs can control the virus. Each of the anti- HIV drugs blocks the virus in different ways to avoid creating strains of HIV that are resistant to single drugs. The highly active antiretroviral therapy (HAART) will help reduce the viral load, improve their lifestyle, restore or preserve immune system function, and reduce morbidity and mortality rate.

6. Medications Non-nucleoside reverse transcriptase inhibitors (NNRTIs): ex. Nevirapine, Delavirdine mesylate Nucleoside reverse transcriptase inhibitors (NRTIs): ex. Abacavir, Zidovudine, Didanosine, Lamivudine, Combivir Protease inhibitors (PIs): ex. Indinavir, Ritonavir, Saquinavir, Nelfinavir mesylate Entry or fusion inhibitors: ex. Enfuvirtude Integrase inhibitors: ex. Raltegravir

7. Indications & Contraindications Indications for HIV/AIDS patient: -Antimicrobial mouth rinse should be recommended -Fluoride treatment should also be considered -Prevent opportunistic infections Contraindications for HIV/AIDS patient: -Patients with blood sugar levels greater than 200 mg/dL can cause a poor response and lead to infection after treatment. -These patients are at high risk for developing oral infection after oral surgery or periodontal debridement and if there neutrophil count is less than 500 cell/mm 3 they will need pre-medication. -Side effects of medications could lead to increased bleeding and infection.

8. Oral Manifestations Linear gingival erythema Necrotizing ulcerative gingivitis & periodontitis (NUG and NUP) Hairy leukoplakia Candidiasis Herpes zoster infection Herpes labialis (intraoral herpes simplex virus infection) Human papilloma virus infection Kaposi’s sarcoma Angular chelitis Xerostomia Apthous ulcers Salivary gland disease

9. Oral Manifestations cont. Pain and oral implications may be caused by disease or from adverse drug effects of HAART. Adverse effects of the primary antiretroviral medication: Zidovudine will cause nausea and vomiting and can lead to dental caries and dental erosion. Topical medications that contain sugar can cause the development of caries. It is our job to inform our patient about the importance of personal oral hygiene care, frequent dental cleanings, and fluoride therapy to help lower viral load and prevent oral infections.

10. Periodontal Management The use of salivary supplements, daily fluoride treatments, and frequent dental visits is important to help control HIV/AIDS impact on the oral health. The combination of dental procedures and antiviral drug therapy will help reduce opportunistic infections from occurring.

11. Pre-Med There is no difference in treatment between patients with HIV/AIDS and those who do not have HIV/AIDs. No pre-medication is necessary unless the patient’s neutrophil count is less than 500 cells/mm 3 and if they are severely neutropenic.

12. Dental Considerations Patient positioning: o Recommended to use semi-supine chair position. Appointment length: o The duration of the appointment will depend on the dental treatment that the patient will receive and the same considerations are used with patients that don’t have HIV/AIDS.

13. Ultrasonic use: o It is safe to use a high-speed ultrasonic instruments for periodontal management with HIV-positive patients. However, dental professionals should prevent contact with splashes and spatter with patient’s position properly and make appropriate use of barriers such as face-shields, surgical masks, rubber dams, and high volume evacuators. Recall Intervals: o Patients with HIV/AIDS should have recall visits to the dental office about every three months. This will help find infections and conditions early in order for patients to receive treatment and prevent a problem. Dental Considerations

14. 1.Select from the following the route that is NOT involved in HIV transmission: A. Exposure to contaminated blood, blood products, or blood-contaminated body fluids B. Infected mother to unborn child C. Intimate sexual contact involving the exchange of semen or vaginal secretions D. Casual contact with a recently seroconverted HIV- positive individual

15. 2.HIV causes significant health changes in infected individuals by: A. Attacking the T4-lymphocytes, thus causing an increase in opportunistic infections B. Attacking plasma cells, thus interrupting the production of antibodies and reducing the host’s resistance to disease C. Increasing capillary permeability, thus causing redness, itching, and swelling in affected areas D. Attacking plasma cells, thus altering antibodies so that they do not recognize the person’s own tissues as friendly

16. 3.Which cell in the immune system is changed, replicated and destroyed in HIV/AIDS: A. T-4 (T-helper lymphocytes) B. T-8 (T-suppressor lymphocytes) C. HTLV-111 D. Retrovirus

18. QUESTIONS??

19. References Centers for Disease Control and Prevention. (2013). HIV/AIDS. Retrieved from http://www.cdc.gov/hiv/statistics/surveillance/incidence/ Ibsen, O. A.C., Phelan, J. A. (2008). Oral pathology for the dental hygienist. United States: Elsevier-Health Sciences Division. Mayo Clinic. (2012). HIV/AIDS. Retrieved from http://www.mayoclinic.com/health/hiv-aids/DS00005 Nelson, D. M. (2000). Saunders review of dental hygiene. United States: Saunders. Pickett, F. A., Gurenlian, J. R. (2010). Preventing medical emergencies: use of the medical history. United States: Wolters Kluwer Health/Lippincott Williams & Wilkins. Sonis, S. T., Fazio, R. C., Fang, L. S. T. (2002). Oral medicine secrets. United States: Hanley & Belfus. Wilkins, E. M. (2012). Clinical practice of the dental hygienist. United States: Lippincott Williams & Wilkins.