Researchers look for culprit behind oral health problems in HIV-positive patients

February 20, 2014, Medical College of Georgia
This is a photo of Dr. Josѐ A.Vazquez, Chief of the Section of Infectious Diseases at the Medical College of Georgia at Georgia Regents University, and Dr. Scott S. De Rossi, Chairman of the Department of Oral Health and Diagnostic Sciences at the Georgia at Georgia Regents University College of Dental Medicine. Credit: Phil Jones

Researchers want to help HIV-positive patients live better by understanding why their essentially dormant infection is still wreaking havoc in their mouth.

Even with meticulous dental hygiene, tooth decay and gum disease, as well as infections by yeast, bacteria, and viruses such as human papillomavirus, continue to plague many patients, said Dr. Josѐ A.Vazquez, Chief of the Section of Infectious Diseases at the Medical College of Georgia at Georgia Regents University.

"If we can improve the of these patients, we believe it will further improve their overall health," Vazquez said.

He and Dr. Scott S. De Rossi, Chairman of the Department of Oral Health and Diagnostic Sciences at the GRU College of Dental Medicine, are investigators on a new National Institutes of Health-funded study that will better determine whether the problem is the HIV infection, the antiretroviral therapy or both.

They have joined researchers at Louisiana State University and Ohio State University in collecting samples from the mouths of 440 HIV-positive patients. They are performing sophisticated molecular tests on the samples that should provide a census of the living organisms in the mouth as well as a T-cell count– an indicator of the activity level of the immune system – then comparing those findings with uninfected individuals.

They also are looking at whether antiretroviral therapy changes the community of oral organisms, called microbiota, by taking a census both before and after therapy starts and by comparing the populations in patients who have oral complications like HPV and yeast, with those who don't.

They are assessing the general health of the teeth and gums as well. "Another big question is, why do these patients have such really bad and ," said Vazquez, a principal investigator on the new study that brings $1.5 million in NIH funding to the university.

While even a healthy mouth is full of bacteria - in fact, more than 600 species play a role in keeping the mouth healthy – Vazquez and De Rossi suspect a different set of bacteria set up shop in these patients.

Vazquez's lab also will be analyzing the different types of yeast recovered from study patients to determine if HIV patients have more aggressive or treatment-resistant strains.

"One of the earliest signs of HIV can be a in the mouth," said Vazquez. In the worst case scenario, this fungal infection can quickly spread into and block the esophagus. "They can't swallow, they can't drink, they can't eat, and so they dehydrate," he said. In fact, when De Rossi sees a patient with an oral yeast infection, he may suggest an HIV test, after ruling out more common causes such as taking an antibiotic for an .

While mostly responsive to antifungal drugs, a few missed doses can give the fungus the opportunity to develop a protective film of sugar, called a biofilm, and become treatment resistant. "To successfully treat a yeast infection, you need a combination of some kind of host immune response and the antifungal medication," Vazquez noted.

HPV, more commonly known as a cause of cervical cancer, was actually not a significant problem in HIV patients until the advent of highly-active , said De Rossi, a study co-investigator. But once it has found a home, the virus can move quickly throughout the mouth and beyond as patients inadvertently bite the area enabling its spread. Treatment tends to work marginally and the virus often resurfaces, spreads, and can cause head and neck cancer.

"We don't know a lot about the evolution of HPV in the mouth of anybody," Vazquez added. "We have to characterize this HPV infection and how it advances in HIV patients from a state of colonization to a tiny lesion, to a little wart, to maybe head and neck cancer that requires major surgery."

The researchers note that anyone whose immune system is compromised by disease or treatment, such as cancer patients receiving chemotherapy or radiation, may experience similar oral health concerns.

Antiretroviral, or cocktail therapies, which have been in use about a decade, have dramatically improved patient survival by inhibiting replication of HIV in all cells so that levels of infection-fighting T-cells can normalize. However, the researchers suspect it does not restore normal microbiota composition in the mouths of these patients.

Georgia Regents Health System follows about 1,800 HIV-positive patients and is adding approximately 15 newly diagnosed patients per month.

Explore further: Recurrent mouth and throat cancers less deadly when caused by virus, study shows

Related Stories

Recurrent mouth and throat cancers less deadly when caused by virus, study shows

February 20, 2014
People with late-stage cancer at the back of the mouth or throat that recurs after chemotherapy and radiation treatment are twice as likely to be alive two years later if their cancer is caused by the human papillomavirus ...

Number of cancer stem cells might not predict outcome in HPV-related oral cancers

January 22, 2014
(Medical Xpress)—New research from The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) suggests that it may be the quality ...

NIH study describes new method for tracking T cells in HIV patients

February 3, 2014
A team of researchers has reported a novel method for tracking CD4+ T cells in people infected with HIV. CD4+ T cells are critical for immune defense against an array of pathogens and are a primary target of HIV. In the study, ...

Increased anal cancer risk from HIV plus HPV dual infection

December 3, 2013
(Medical Xpress)—Human papillomavirus, or HPV, which can cause cervical cancer in women, is also known to cause anal cancer in both women and men. Now, a study led by researchers at the UCLA School of Nursing has found ...

Study identifies population of stem-like cells where HIV persists in spite of treatment

January 12, 2014
Although antiviral therapy against HIV suppresses viral replication and allows infected individuals to live relatively healthy lives for many years, the virus persists in the body, and replication resumes if treatment is ...

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.