Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report.
In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.
Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA.
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Vernon
Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia and Dental Hospital, and Sri Lanka Air Force Station Colombo, Sri Lanka, Australia.
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Jayashantha
College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe.
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Chidzonga
Department of Morphology, Stomatology Physiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
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Komesu
Oral Medicine, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia and Cancer Services, Gold Coast University Hospital, Queensland Health, Qld, Autralia, Australia.
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Nair
Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia.
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Johnson
D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology; D054625:Healthcare Disparities; D006801:Humans; D009059:Mouth Diseases / Q000139:chemically induced*; D009062:Mouth Neoplasms / Q000453:epidemiology*; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology*; D017201:Virus Shedding
D044966:Anti-Retroviral Agents