Oral health

Strengthening the prevention of HIV/AIDS-related oral disease: a global approach

Community Dentistry and Oral Epidemiology 2004; 32:399-401
Guest editorial: Dr Poul Erik Petersen, Chief, WHO Oral Health Programme

The HIV/AIDS epidemics are one of the greatest challenges ever to global well-being. Approximately 42 million people were infected with HIV by the end of 2002, and millions have already died of AIDS. Many more people are affected because their parents, other family members, friends and co-workers have died from AIDS or are infected with HIV. HIV/AIDS is the fastest growing threat to development today and the epidemic is particularly severe in Sub-Saharan Africa and Asia. National programmes, international organizations, civil society, communities and individuals have responded to the epidemic. The initial efforts were often weak and scattered as the full nature and scope of the threat were not comprehended. As the epidemic has progressed, understanding of the complex causes and effects has increased. The greatest challenge in responding to HIV/AIDS at present is ensuring that proven, gender sensitive strategies for prevention and care are widely implemented to a level where there will be significant impact on the epidemic.

Oral health services and professionals can contribute effectively to the early diagnosis, prevention and treatment of this disease. A number of studies have demonstrated that approximately 40–50% of HIV positive persons have oral fungal, bacterial or viral infections often occurring early in the course of the disease. Oral lesions strongly associated with HIV infection are pseudo-membranous oral candidiasis, oral hairy leukoplakia, HIV gingivitis and periodontitis, kaposi sarcoma, non-Hodgin lymphoma. Dry mouth as a result of decreased salivary flow rate may not only increase the risk of dental caries but further impact negatively on qualify of life because of difficulty in chewing, swallowing and tasting food.

The World Health Organization (WHO) has worked for control of HIV/AIDS-related oral conditions through several activities. The WHO Oral Health Programme has prepared a guide (1) which is intended to provide a systematic approach to the implementation of epidemiological studies of oral conditions associated with HIV infection; to provide guidelines for the collection, analysis, reporting and dissemination of data from such studies, and to facilitate comparison of findings from different studies. It aims also to encourage oral health personnel and public health practitioners to make oral health status an integral part of optimum case management and introduction of surveillance activities of oral diseases associated with HIV infection.

Recently, WHO analysed the global burden of oral disease and outlined the strategy and approaches to improved oral health in the 21st century. According to the World Oral Health Report 2003 (2) priority is given to effective prevention of oral manifestations of HIV/AIDS through additional actions. These actions are integral components of WHO and joint United Nations global programmes for control of HIV/AIDS (3–5).

The WHO Oral Health Programme, in collaboration with other WHO technical programmes and WHO Collaborating Centres in Oral Health, will facilitate and coordinate the expansion of successful initiatives through technical and managerial support. Such activities may focus on:

  • Identification of the most indicative oral manifestation of HIV/AIDS.
  • Involvement of oral health personnel in the documentation of HIV/AIDS to ensure appropriate medical evaluation, prevention and treatment.
  • Training of other health professionals on how to screen for oral lesions and extra-oral manifestations. Using the ‘Train the trainer’ approach in order to reach health care workers at local community or village level.
  • Dissemination of information on the disease and its prevention through every possible mean of communication.
  • WHO technical support to meetings at regional or inter-regional levels aiming at sharing country experiences in monitoring HIV/AIDS prevention and lifestyle modification through campaigns and community programmes.

WHO co-sponsored conference on oral health and disease in HIV/AIDS

Prior to the XVth International AIDS Conference held in Bangkok, Thailand, from 11–16 July 2004, the Fifth World Workshop on Oral Health and Disease in AIDS was held in Phuket, Thailand, from 6–10 July 2004. The workshop was organized by the Prince of Songkhla University, Thailand; the International Association of Dental Research, National Institutes of Health, NIDCR, USA; University of California - San Francisco Oral AIDS Centre, and co-sponsored by the World Health Organization.

The importance of oral health in HIV/AIDS was analysed by the more than 150 researchers and public health administrators during this global conference, focusing on biologic, clinical and public health aspects of HIV infection. The conference programme included presentations and workshops on current perspectives in epidemiology and management of HIV disease; pathogenesis of HIV and vaccine research; oral lesions in HIV/AIDS; collaborative research and funding mechanisms; identification of health care needs in children and adults; management of oral diseases, prevention and health promotion, and the interrelationship between oral health and general health.

The participants of 27 countries unanimously issued the Phuket Declaration and encouraged national and international health authorities, dental associations and research institutions to strengthen their efforts for the effective control of HIV/AIDS.

The WHO Oral Health Programme is committed to work for inter-country exchange of information and experiences in prevention of oral lesions related to HIV infection and health promotion.

References

1. Melnick SL, Nowjack-Raymer R, Kleinman DV, Swango PA. A Guide for Epidemiological Studies of Oral Manifestations of HIV Infection. Geneva: WHO, 1993.

2. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st Century – the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31(Suppl. 1): 3–24.

3. World Health Organization. Global Health-Sector Strategy for HIV/AIDS 2003-1007. Geneva: WHO, 2003.

4. World Health Organization: The World Health Report 2003, Shaping the Future. Geneva: WHO, 2003.

5. Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the Global AIDS Epidemic 2004. Geneva: UNAIDS, 2004.

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