HIV - infection and Periodontal disease: a Hidden Truth

The association of periodontal disease in HIV-infected patients had been initially considered to be the first clinical expression or indication of profound immunodeficiency and stage of HIVdisease as expressed by CD 4 –cells in the peripheral blood circulation. Three entities were majorly described and are strongly associated with HIV-infection include (a)Linear gingival erythema(LGE), (b)Acute necrotizing ulcerative gingivitis(ANUG) and (c)Acute necrotizing ulcerative periodontitis (ANUP). Many studies and case reports initially had reported higher prevalence of periodontal disease and also higher severity and rapid progression of existing gingivitis or periodontitis which was clinically assessed by measuring periodontal pockets and attachment loss. The prevalence and severity of periodontal disease in HIV-seropositve or AIDS patients is due to severe immune suppression expressed by rapid depletion of CD 4 -cells/ Thelper cells.HIV –infected patients are more prone to get periodontal disease when the CD 4 -cell count falls below 200 cells/ μL or the stage of HIV-infection progresses to AIDS. In contrast, considerable variation has been observed in recent studies that there were less severity of progression and prevalence of periodontal disease in AIDS patients whose CD 4 -cell is below 200 cells/μL compared to HIV-infected patients whose CD 4 cell count is above 200 cells/μL. The aim of this article is to review old and present concepts based on studies and case reports and also to encourage researchers to explore the changing face of disease progression in HIV-positive individuals.