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UNC HIV Oral Health Demonstration Project

HIV/AIDS. According to the Centers of Disease Control and prevention, HIV/AIDS is defined as the following:HIV:Human immunodeficiency virus. This is the virus that causes AIDS. HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ab

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UNC HIV Oral Health Demonstration Project

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    1. UNC HIV Oral Health Demonstration Project Jo-Ann A. Blake, RDH,MPH PI: Jennifer Webster-Cyriaque, DDS,PHD, University of North Carolina School of Dentistry 1

    2. HIV/AIDS According to the Centers of Disease Control and prevention, HIV/AIDS is defined as the following: HIV: Human immunodeficiency virus. This is the virus that causes AIDS. HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease. AIDS: AIDS stands for acquired immunodeficiency syndrome. AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infections. When someone has one or more of these infections and a low number of T cells, he or she has AIDS. HIV significantly diminishes the immune systems ability to fight against infection Oral infections are notoriously increased in HIV/AIDS causing significant morbidity for the patient. Our ability to collectively treat these infections here in NC has been suboptimal 2

    3. HIV/AIDS and unmet needs for dental care in North Carolina In NC, dentists in private practice delivered the majority of direct patient care services to all segments of the population. The dental care access problem in North Carolina is acute and worsening. North Carolina ranks 47th of the 50 states with a ratio of 4.1 dentists per 10,000 while the national average is 6.0 dentists per 10,000. The growth of the dental workforce has not kept up with the growth of the state. These data show that the dentist to population ratio has remained without growth since 1987. North Carolina is expected to experience the 5th largest population increase among the 50 states. While the population for the US is expected to grow by 29.2%, the North Carolina population is projected to grow by 51.9%. Only a fraction of private dentists within North Carolina accept Medicaid. As of 2004, the current dentist to Medicaid ratio was 1:753. While many dental professionals believe that the "healthy" HIV infected patient with a CD-4 count above 200 can usually receive routine dental treatment in the office of a general practitioner, this often does not occur. 3

    4. Problems associated with HIV/AIDS Progression and Oral Disease in the target population Oral diseases are common in severe immunosuppression (e.g. post transplant, AIDS), and are often the first manifestations of HIV-1 infection and AIDS. The bacterial, fungal and viral organisms that cause these lesions provide an arduous challenge to the immunocompromised host. A diagnosis of HIV, regardless of CD4 count, is used against the patient as well as their inability to pay. This generally results in many HIV infected patients only seeking emergent dental care. The numbers of methamphetamine and other drug users who've contracted HIV have also increased. Drugs also significantly influence the intraoral state. For some, oral health is overlooked due to the patients’ inability for self care or the caregivers’ lack of knowledge or training with regard to the HIV/AIDS population Finally, the relationship between oral infection and the systemic health of the HIV/AIDS patient is not well defined. 4

    5. How are we addressing these needs? We will participate in efforts to decrease oral health morbidity in HIV/AIDS population by implementing a comprehensive dental care program that is concurrent with HIV diagnosis The UNC Oral Health Demonstration Project HRSA Special Project of National Significance HIV Oral Health Initiative 5

    6. Goals and objectives The mission of this project is: to develop and evaluate a comprehensive, innovative, and replicable oral health plan for the HIV population by implementing the following: 1) Determine the extent of dental disease and oral lesions in this newly diagnosed population compared with a population of traditionally referred HIV patients based on examination and biologic markers. 2) Provide comprehensive dental treatment and regular recalls, to eliminate dental disease and promote oral health. 3) Develop a dissemination plan for education to providers and clients on oral manifestations of HIV/AIDS and for dissemination of results of the study to the HIV population, HIV healthcare providers and dental care providers. 4) Develop and implement evaluative tools and prognostic indicators to determine the likelihood of the development of oral disease in the HIV AIDS population. 6

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