Avaliação de alterações orofaciais em adolescentes infectados pelo vírus da imunodeficiência humana por transmissão vertical em uso de terapia antirretroviral

Abstract

Orofacial outcomes in HIV perinatally infected adolescents undergoing highly active antiretroviral therapy. More than two million adolescents are living with Human Immunodeficiency Virus (HIV) worldwide in 2018. Morbidity and mortality related to HIV has been reduced since highly active antiretroviral therapy (ART) was firstly introduced in 1996. However, longterm effects of HIV infection, adverse effects of ART and poor adherence to ART may lead to metabolic disorders, resistance to antiretroviral drugs and changes in the epidemiology of opportunistic diseases. The purpose of this retrospective study was to assess the frequency of orofacial outcomes among HIV perinatally infected adolescents undergoing ART in a reference center for HIV treatment from 1999 to 2018. A total of 137 individuals aged between 10 and 19 years had their medical records reviewed. Information on the HIV viral load, CD4+ cell count, ART regimen, events of non-adherence to the therapy and prolonged ART discontinuation was also recorded. Cervical and submandibular lymphadenitis (28.83%), dental caries (20.93%) and gingival/periodontal outcomes (7.44%) were the most frequent orofacial lesions. Detectable viral load and CD4+ cell count under 500 cells/L were associated with a higher risk of lymphadenitis [OR 95% CI = 2.61 (1.16 5.88) and OR 95% CI = 2.34 (1.13 4.82)]. Prolonged ART discontinuation was associated with detectable viral load (p = 0.005), CD4+ cell count under 500 cells/L (p = 0.001). Lesions strongly associated with HIV and lesions commonly associated with HIV were observed among adolescents, who had longer ART discontinuation and more prolonged ART discontinuation events. Lesions associated with HIV had low frequency among the adolescents evaluated. Long-term ART use and long-term exposure to HIV virus may have changed the prevalence of orofacial lesions among HIV perinatally infected adolescents. Health care providers should be aware of the epidemiology of orofacial lesions among HIV adolescents and should consider information on the outcomes related to the long-term ART use and long-term exposure to HIV during the surveillance and counseling of infected individuals, so that optimal oral health care could be provided. Keywords: HIV. Adolescent. Oral diagnosis. Highly Active Antiretroviral Therapy. AntiHIV Agents. Vertical transmission of Infectious Disease.