原文題目

口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處)： HIV infection and periodontal diseases: An overview of the post-HAART era. Oral Diseases 2011;17:13-25

原文作者姓名： Mataftsi M, Skoura L, Sakellari D

通訊作者學校： University of Thessaloniki, Thessaloniki, Greece 報告者姓名(組別)： 顏浩軒 intern K 組

報告日期： 2011/07/25

內文：

I. Introduction

 Highly active antiretroviral therapy (HAART) modified the course of HIV disease after 1995 with longer survival and improved quality of life

 HAART cannot eradication of HIV infection, infected CD4 + T-cells is established during the earliest stages

 Toxic side effects of HAART

 Hypersensitivity

 Lactic acidosis

 Higher blood lipids

 Anemia

 Neuropathy

 Lipodystrophy

 Pancreatitis

II. Features of periodontal lesions in HIV-infected adult p'ts

 Seven cardinal oral lesions 1. Oral candidiasis

2. Oral hairy leukoplakia 3. Kaposi sarcoma

4. Non-Hodgkin lymphoma

5. Linear gingivitis erythema (LGE) 6. Necrotizing ulcerative gingivitis (NUG) 7. Necrotizing ulcerative periodontitis (NUP)

 5.6.7 strong associated with HIV

 Criteria of HIV-related oral lesions

 Not well defined in children

 Linear gingivitis erythema (LGE)

 Distinct fiery red band along the margin of gingiva

 Anterior teeth , common extend to posterior teeth

 Bleeding , discomfort

 Petechia-like patch on attach or free gingiva

 Necrotizing ulcerative gingivitis (NUG)

 Rapid onset and painful inflammation of gingiva

 Rapid destruction of soft tissue

 Necrotizing ulcerative periodontitis (NUP)

 Bleeding , sharp pain ulcerated gingival papillae

 Rapid and extensive soft tissue necrosis

 Advanced loss of periodontal attachment , bone exposure

 Risk factor for periodontal disease in HIV-infected

 CD4⁺ cells counts , viral load , species of microbiota

 CD4⁺ cells counts < 200 cells mm^-3 , immune deterioration

 HAART therapy era , CD4⁺ cells counts are low

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III. Prevalence of periodontal lesions in HIV-infected individuals

 HAART change epidemiology of opportunistic infection in HIV-infected p’ts

 HAART also decreased the mortality and morbidity of HIV infection

 Oral candidiasis appears to be the most decreased lesion after HAART IV. Bacteria associated with periodontal disease in HIV-infected patients

 Putative periodonopathogenic bacteria

 Aggregatibacteractinomycetemcomitans

 Fusobacterium nucleatum

 Porphyromonas gingivalis

 Prevotella intermedia

 Tannerella forsyt hia

 Treponema denticola

 Not usually linked with periodontal disease

 Enterococcus faecalis

 Acinetobacter baumanii

 Pseudomonas aeruginosa

 Campylobacter pylori

 Complex combinations of microbes in subgingival area in HIV-infected p’ts

 Subgingival biofilm microorganisms active inflammatory cells

 Polymononuclears (PMN)

 Lymphocytes

 Macrophages

 Host defense factor

 Hypotonic nature of saliva

 Endogenous inhibitors of HIV

 Particularly secretory leucocyte protease inhibitor (SLPI) that blocks HIV infection in several cell-culture systems

 Salivary mucins MUC5B and MUC7

 Trap and aggregate the virus and can inhibit it by 100%

 sIgA antibodies which neutralize HIV

 Antimicrobial peptides such as a and b-defensins

 Histatins and lactoferrin

 Infectious virions and proviral HIV-1 DNA in saliva from GCF

 Include serum and HIV-containing macrophages and lymphocytes Increased during periodontal infection

 Dendritic cells (DCs) and macrophages in gingival express C-type lectin receptors which are targets for HIV and other microbes

 DC-SIGN (Dendriticcell- specific ICAM-3-grabbing non-integrins, CD209),

 MR (mannose receptors, CD206)

 Langerin (CD207)

 For patients with chronic periodontitis, an increase in the number of dermal dendritic cells (DDCs) expressing DC-SIGN receptors and a trend for increased mannose receptors identified in the inflamed gingival lamina propria

 Dentritic cells, DDCs and LCs, form immune conjugates with CD4 + T cells in the lamina propria and under these conditions it is possible for dendritic cells to transfer HIV in the T-lymphocytes in the inflammed gingival lamina propria

 HIV+⁄ AIDS patients under HAART

 Present CD4 + lymphocyte counts of >500 cells ml)^-1

 Undetectable viral loads can suffer opportunistic oral HIV-associated

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infections

V. Conclusions

 HAART significantly modified the course of HIV disease

 Oral candidias infection more significantly decreased after the introduction of HAART

 Prevalence and course of periodontal lesions have also been modified

題號 題目

1 下列何者不是 AIDS 病人口內常見的病徵?

(A) Hairy leukoplakia (B) Candidiasis

(C) Necrotizing ulcerative periodontitis (D) Hairy tongue

答案( D ) 出處：Ch.7 p.237 ~ p.242 Hairy tongue 為抽菸常見舌部病徵

題號 題目

2 下列與 AIDS 相關的口腔病灶，何者所發生的致病源與其他三者不

同

(A) Candidiasis (B) Herps zoster (C) Hairy leukoplakia (D) Kaposi’s sarcoma 答案( A ) 出處：Ch.7 p.230 ~ p.250

(A) Candidiasis 為 fugus infection

(B) Herps zoster 為 Herps simplex virus (HSV)引起 (C) Hairy leukoplakia 為 Epstein-Barr virus (EBV)

(D) Kaposi’s sarcoma 為 Human herpsvirus type 8 (HHV-8)引發