GRADY HEALTH SYSTEM Deepa Reddy 1, Anitra Sumbry 1, David Reznik 2, Clifford Gunthel 1, Judy Mc Guire 2, Minh Ly Nguyen 1 1 Emory University School of Medicine, 2 Grady Health Systems, Atlanta, GA PREVALENCE OF DENTAL CARIES, PERIODONTAL DISEASE AND ORAL LESIONS IN AN URBAN RYAN WHITE-FUNDED DENTAL CLINIC IN THE HAART ERA Abstract Poster#1063 Address correspondence to : Minh Ly Nguyen, MD Emory University 69 Jesse Hill, Jr. Drive Atlanta, GA Background: Oral diseases were identified as a significant issue early in the AIDS epidemic and they continue to be so today. Oral manifestations of HIV disease, such as candidiasis, hairy leukoplakia, and periodontal disease occur in approximately 30% to 80% of HIV/AIDS patients. Highly active antiretroviral therapy (HAART), despite reducing the incidence of some oral health conditions, has been associated with increased incidence and frequency of other problems such as oral warts and salivary gland disease. We evaluated the prevalence of oral findings and characteristics of patients attending an urban, Ryan White-funded dental clinic. Methods: We surveyed 100 HIV infected patients who were seen in the dental clinic within the preceding 3 months. We administered a questionnaire on demographics, sexual activities, and substance use. Baseline labs and recent dental exam findings were recorded. Results: Patients’ median age was 46 (range 26-66); 65% of participants were male, 79% were African Americans, 74% reported past or current tobacco use, 43% reported past or current regular alcohol use; 34% reported receptive oral intercourse within the past 3 months and 88% reported seeing a dentist two or more times per year. The proportion of patients seen in the dental clinic within 3 years of HIV diagnosis was lower before year 2000 than after 2000 (34.3 % versus 66.7%, p=0.0014). Median nadir CD4+ was 62 cells/μL (range: ). Median recent CD4+ cell count was 393 cells/μL (range ) with 55% having CD4+ count above 350 cells/ μL; 76% had an undetectable viral load with 92% being on HAART. Dental caries were present in 66% of patients, 54% had gingivitis, and 28% had periodontal disease. Fourteen patients (14%) presented with oral lesions including 7 patients (7%) with oral warts, 5 with oral candidiasis and two presented with an oral ulcer. Conclusion: Despite more aggressive and earlier dental care and improved immune response (CD4+>350 cells//μL in 55% of patients) and controlled viral load, the presence of dental caries, periodontal disease and oral lesions among HIV infected patients is still significant. Regular ongoing dental visits and treatment are critical to minimizing long-term oral health complications for people living with HIV disease. Demographics TotalMalesFemalesP value N Median age Range Race African Americans Caucasians Other (72%) 11(17%) 7(11%) 32(91%) 2(6%) 1(3%) 0.08 Sexual orientation Heterosexual Homosexual Bisexual (17%) 38(58%) 16(25%) 31(88%) 1(3%) 3(9%) < Receptive oral intercourse None A few times a month Multiple times per week (59%) 23(35%) 4(6%) 28(80%) 7(20%) Tobacco use Never Former Current <20pack-years >20pack-years (21%) 8(12%) 25(38%) 17(26%) 11(31%) 9(26%) 11(31%) 4(11%) 0.20 Alcohol use Never Former Current Occasional Regular (5%) 28(43%) 30(46%) 14(21%) 5(14%) 13(37%) 9(26%) 8(23%) 0.45 Other illicit drugs Cannabis Cocaine Metamphetamine (69%) 35(54%) 10(15%) 19(54%) 18(51%) 3(9%) 0.12 Nadir CD4 + count <200 cells/µL cells/µL >350 cells/µL (95%) 3(4%) 0 28(85%) 3(9%) 2(6%) 0.07 Current CD4 + count <200 cells/µL cells/µL >350 cells/µL (26%) 16(25%) 30(46%) 4(11%) 6(17%) 25(71%) 0.03 On HAART9260(92%)32(91%)0.2 Viral load <80 copies/mL copies/mL >1,000copies/mL (76%) 9(14%) 6(10%) 29(83%) 4(11%) 2(6%) 0.39 HIV diagnosis Before 2000 After (74%) 17(26%) 29(83%) 6(17%) 0.33  Oral health plays a significant role in an individual’s overall health status, and people living with HIV/AIDS (PLWHA) have significant oral disease such as oral candidiasis, hairy leukoplakia, viral and aphthous oral ulcers and periodontal disease which occur in approximately 30% to 80% of HIV/AIDS patients.  Factors contributing to dental disease in PLWHA include:poor oral hygiene, tobacco, alcohol, xerostomia (losing the natural antimicrobial effect of saliva which would lead to dental cavities, gingivitis and periodontitis), illicit drug use such as metamphetamine (with its composition of muriatic acid, sulfuric acid and lye which can cause dental corrosion), and limited access to dental care.  Recently, two new problems have emerged: oral warts caused by the human papillomavirus (HPV) as well as oral squamous cell carcinoma.  This study was done to assess the characteristics of PLWHA who attended the Grady Infectious Disease Clinic Oral Health Center and the prevalence of oral diseases among PLWHA who have ready access to dental care and to antiretroviral treatment. Background Methods We surveyed one hundred patients who attended the Grady Infectious Disease Clinic Oral Health Center within the preceding three months. We administered a detailed questionnaire on demographics, sexual activity and substance use as well as dental and medical care history. Baseline laboratory results and recent dental exam findings were recorded. Statistical analysis was performed using SAS statistical software (version 9.1, SAS institiute, Cary,NC). Continuous variables were analyzed using Student t test, and categorical data were analyzed by chi square or Fisher exact test. Significance for all comparisons was set at p<.05. Results Conclusion References Acknowledgement  After year 2000, the proportion of PLWHA having dental care within 3 years of HIV diagnosis has nearly doubled in our dental clinic with women participating more in dental care.  There is a high prevalence of smoking, alcohol and illicit drug use which will affect oral health.  However, there is still significant dental disease with still a large prevalence of dental caries(66%), gingivitis( 54%), as well as periodontitis( 28%).  Oral warts were found in 7% of patients,exclusively in men.  People that are HIV positive should have dental exams every six months to check for tooth decay, periodontal disease, or gingivitis. Periodontal disease needs to be treated early to prevent tooth loss. Efforts to improve oral health should also target smoking cessation programs and illicit drug use counseling.  Regular oral exams would also help to detect oral cancer early given this high risk population (tobacco, alcohol, metamphetamine, and oral warts). This work was partially supported by the Emory Center for AIDS Research (P30AI050409). Figure 1 - ????????? Table 2- Prevalence of dental diseases and oral lesions Figure 2 - Change in anaerobic threshold of Hemoglobin per(100mL/min/m2VO2) for P50 change from 26.6 torr 1- Cavasin Filho JC, Giovani EM. Xerostomy, dental caries and periodontal disease in HIV+ patinets. Braz J Infect Dis ;13(1): Cameron JE, Hagersee mE. Oral HPV complications in HIV- infected patients. Curr HIV/AIDS Rep 2008; 5(3): Reznik DA. Oral manifestations of HIV disease. Top HIV Med 2005; 13(5): King MD, Reznik DA, O'Daniels CM, et al. Human papillomavirus-associated oral warts among HIV seropositive pateints in the era of highly antirtroviral therap: an emrging infection. Clin Infect Ids 2002; 34(5): P 50 =20 torr P 50 =34 torr P 50 =26.6 torr