By: Dr. Nur Fauziani Zainul Abidin
As we observe World AIDS Day, it’s essential to highlight a frequently overlooked aspect of HIV/AIDS management: oral health. Malaysia is currently ranked seventh highest in adult prevalence of HIV/AIDS in Asia. And according to The Joint United Nations Programme on HIV/AIDS (UNAIDS), in 2020, Malaysia recorded an incidence rate of 8.5 cases per 100,000 population, a 70 percent drop from 28.5 cases per 100,000 people in 2002. As an oral medicine specialist and oral pathologist, I’ve seen how HIV/AIDS can significantly impact a patient’s oral health, and conversely, how oral health can be a window to understanding one’s overall well-being in the context of this disease.
HIV is a virus that weakens a person’s immune system by attacking cells that fight infection. If not treated, it can lead to AIDS, a more serious condition where the body can’t fight off diseases well. Decreased immunity leads to secondary infections and certain cancers. Therefore, people with HIV infection are at higher risk for developing oral health problems. Oral lesions in HIV patients are particularly significant as they can reveal undiagnosed HIV infection, indicate disease progression, and are often early signs of AIDS, as certain oral lesions are associated with lower immune cell counts.
Common oral health issues in those with HIV/AIDS include chronic dry mouth, gum disease (gingivitis), bone loss around the teeth (periodontitis), ulcers, oral warts, white thrush (an oral fungal infection), and Kaposi’s Sarcoma, a type of cancer that manifests as patches of abnormal tissue growth, varying in colour from red to purple or brown. Interestingly, except for Kaposi’s Sarcoma, these oral problems are not exclusive to HIV patients. However, due to a significant reduction in immunity, these conditions manifest differently in those with HIV, typically being more severe and extensive. Furthermore, HIV patients may develop resistance to standard antiviral or antifungal medications, complicating their disease management and control.
Though unrelated to a person’s level of immune suppression, individuals with HIV are also at increased risk for tooth decay and poor oral health. Tooth decay in HIV patients can be due to various factors like poor oral hygiene, inadequate diet, unusual bacterial growth and decreased saliva production secondary to HIV-associated dysfunction of the glands. Sadly, some of these factors are exacerbated by societal stigma, due to fear of acquiring HIV as well as the association of HIV with deviant behaviour.
HIV-related stigma has always been a significant issue and may negatively impact oral health care utilization in patients living with HIV/AIDS. Research indicates that unemployment, lifestyle choices like smoking, alcohol use, drug addiction, and a history of imprisonment correlate with poorer oral health outcomes. For instance, the risk of being toothless is significantly higher in patients struggling with addiction. This mirror the harsh reality of how societal and economic factors, compounded by the stigma surrounding HIV/AIDS, can lead to neglect of oral health.
As we commemorate World AIDS Day, it’s imperative to recognize the integral role of oral health in the management and understanding of HIV/AIDS. The journey of someone living with HIV/AIDS is not just about managing the virus but also about addressing the myriad health issues that arise, including oral health.
It’s a call to action for all of us —healthcare providers, policymakers, and society at large— to not only provide medical care but also foster an environment of understanding and support for those living with HIV/AIDS. In doing so, we can help improve not only their oral health but their overall quality of life, underscoring the importance of comprehensive care in the journey towards managing HIV/AIDS.
The author is a Dental Lecturer at the Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, Universiti Malaya. She may be reached at firstname.lastname@example.org