School of Oral Health Sciences (ETDs)
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Item Prevalence and factors of HIV associated Oral Kaposi Sarcoma at Wits Oral Health Centre, Johannesburg(University of the Witwatersrand, Johannesburg, 2024-07) Chetty, Hasita; Padayachee, Sankeshan; Mafojane, TumaneIntroduction: HIV associated Oral Kaposi Sarcoma (OKS) is a neoplasm predominantly occurring in immunocompromised patients. Therefore, it is often observed in an HIV positive and AIDS population (Moore & Chang, 2003). KS is caused by the Kaposi Sarcoma Herpes Virus (KSHV) or Human Herpes Virus-8 (HHV8) (Naidoo et al, 2016). The risk of acquiring KS increases in the presence of HIV infection and immunosuppression (Kamulegeya & Kalyanyama, 2008). HIV-KS can occur at any stage of HIV infection but has been more prevalent at the stage of AIDS or severe immune impairment (Khammissa et al., 2012). Both HHV8 infection and HIV/AIDS are highly prevalent in Africa (Kamulegaya and Kalyanyama, 2008). There is a lack of current evidence documenting the relationship between HIV/AIDS and OKS since the implementation of ART, therefore this study intends to augment the existing literature. This study aimed to determine the prevalence and factors of HIV associated OKS, on histopathologically diagnosed patients attending the WITS Oral Health Centre, Johannesburg, between 2008 and 2018. This period predates and postdates the roll out of ART in the South African public health sector in 2012 and speaks to the relationship between ART and the occurrence of HIV associated OKS. Materials and Method: This is a cross-sectional study using records from the Wits Oral Health Centre (WOHC) and National Health Laboratory Service (NHLS). The study period is 10 years from January 2008 to December 2018. Prevalence of OKS was calculated based on patients with a positive histopathological diagnosis of OKS within the study period from the NHLS database. Ethical Considerations: Permission was requested from the Academic Affairs and Research Management System (AARMS) National Health Laboratory Service (NHLS) and WOHC to access patient files. Records of patients with a positive OKS histopathological diagnosis were noted. They were allocated a study number and patient number on a data sheet. The corresponding patients’ files were accessed from WOHC to attain further information (as per the data sheet). Patient confidentiality was be maintained as no names were recorded and files were allocated a number for cross-referencing between NHLS and WOHC data. Ethics clearance was attained from the Wits Human Research Ethics Committee to carry out this study. Results: The prevalence of OKS that was found in this population (137679 patients seen at WOHC) was 0.017432%(n=24). There were more females that presented with OKS than males. The mean age of presentation was 39.11 years of age (SD 12.459). There was a significant relationship between high viral loads and a low CD4 count. The palate was the site most frequently biopsied in diagnosed OKS cases. Conclusion: The prevalence of OKS over the study period was very low. The mean age of OKS presentation was 39.21 years of age. More females presented with HIV associated OKS than males and the palate was the site, from which most biopsy samples were taken in OKS diagnoses. There is a significant relationship between high viral loads and low CD4 cell counts. This study is suggestive that a possible reason for the low number of OKS cases could be administration of ART by state institutions in South Africa, this can be further investigated to establish the effect of ART on OKS.Item Risk factors for caries and periodontal diseases: a comparative4 study among HIV-positive and HIV-negative adults in nyarugenge5 district, Rwanda(University of the Witwatersrand, Johannesburg, 2024) Murererehe, JulienneDental caries and periodontal diseases are among HIV-positive persons' most frequent oral conditions. These common oral diseases contribute to the impairment of general health and well- being. Dental and periodontal problems among HIV-positive individuals are more severe and difficult to manage than dental and periodontal problems among HIV-negative people. Thus, risk factors for caries and periodontal diseases must be controlled for comprehensive oral health and the general well-being of HIV-positive patients. The burden of oral diseases is reported to be high in Rwanda. Nearly 65% of the oral health survey participants had experienced dental caries and above 54% had untreated cavities. In addition, dental calculus was found among 60% of participants. More than 34% had oral debris. Surprisingly, more than 70% of this population has never visited dentists or dental facilities. This evidence gives impetus to undertake more focused investigations on oral diseases in Rwanda, particularly among HIV-positive people. Therefore, this study sought to assess the risk factors for caries and periodontal diseases among HIV-positive and negative adults in Nyarugenge District, Rwanda Methods This research used a mixed-method approach (qualitative embedded design). For the quantitative part, a comparative cross-sectional study was conducted among 200 HIV-positive and 200 HIV- negative adults aged ≥18 years. Consecutive and purposive sampling method was used to select participants for quantitative and qualitative parts of the study respectively. Caries was assessed using the Decayed (D), Missing (M), and Filled Teeth (F) index (DMFT). Periodontal disease was assessed using the Plaque Index (PI), Community Periodontal Index of Treatment Need (CPITN), and Clinical Attachment Loss (CAL). Oral health Related Quality of Life (OHRQoL) was assessed using the oral health impact profile short version (OHIP-14). Descriptive statistics, Chi-square test, t-test, Cronbach alpha, and multiple logistic regression were applied to analyse quantitative data using Stata version 15. For the qualitative data collection, in-depth interviews (IDIs) were conducted among 10 HIV-positive and 11 HIV-negative adults with caries and periodontal diseases using a semi-structured interview guide. Thematic content analysis using an inductive approach was applied for data analysis of IDIs. NVivo software version 11 was used to code and organize the data. Results A higher proportion (50.5%) of HIV-positive adults had experienced caries (DMFT>0) compared to HIV-negative counterparts (40.5%) and the difference was statisticaly significant (p=0.045). The prevalence of D was higher (23.5%) among HIV-positive compared to HIV-negative adults (13.6%) (p=0.011). The Mean (SD) DMFT score among HIV-positive and HIV-negative participants were 2.28 (3.68) and 1.29 (2.21) respectively (p=0.001). The predictors of caries in HIV-positive persons were being female (OR= 2.33; 95%CI= 1.14-4.75), frequent dental visits (OR= 4.50; 95% CI=1.46-13.86) and detectable RNA viral load (OR= 4.50; 95% CI=1.46-13.86). Among HIV-negative participants, the middle age range (36-45 years) [OR= 6.61; 95%CI=2.14- 20.37], and frequent dental visits were significantly associated with caries (OR=3.42; 95%CI: 1.337-8.760). For periodontal status, having dental calculus was the most prevalent item of the CPITN found among HIV-positive 168 (84%) and 182 (92%) HIV-negative individuals. The mean (SD) score for CAL was higher in HIV-positive persons 1.23 (0.95) compared to HIV-negative counterparties 0.99 (0.75). The difference was statistically significant (p=0.003). Being a male was a predictor of having dental plaque and a need for periodontal treatment for both HIV-positive (PI OR: 2.90 (95%CI=1.26-6.66)); (CPITN OR: 3.33 (95%CI=1.14-9.70)) and HIV-negative respondents (PI OR:3.28 (95%CI=1.48-7.28)); (CPITN: OR: 7.78 (95%CI=1.04-58.07)). A higher percentage of HIV-positive individuals had poorer OHRQL than HIV-negative counterparties in all items of OHIP-14 except for OHIP3 (found it uncomfortable to eat any foods because of problems with teeth or mouth) and OHIP-14 items (being totally unable to function because of problems with teeth or mouth). The findings revealed significant results regarding OHIP1 “trouble pronouncing any word” with a prevalence of 11(2.5%) and 9(2.25%) in HIV-positive and HIV-negative participants, respectively. Also, HIV-positive persons had higher percentage 11(2.75%) for the OHIP 13 item “life not satisfying due to teeth and mouth problems” than HIV-negative counterparties 8(2%) and the difference was statistically significant p≤0.05. Moreover, dental caries was significantly associated with poor OHRQoL among HIV-positive and HIV-negative participants for all 14 items of OHIP-14 tool. There was no association between periodontal disease and OHRQoL in both HIV-positive and HIV-negative adults. Two broad domains and five themes emerged from the interviews. The first broad domain was “perceptions on causes of oral diseases” with 2 themes (individuals and external themes). The second broad domain was “perceptions on oral diseases effect” with 3 themes (physical or functional effect, psychological effect and social effect themes). Conclusion and recommendations This research showed a higher prevalence of caries and CAL among HIV-positive adults than HIV- negative counterparts. Also, the mean (SD) PI value was significantly higher in HIV-positive adults compared to the mean PI value in HIV-negative individuals. The reported higher prevalence of caries in HIV-positive persons was associated with being female, detectable viral load, and frequent dental visits. Periodontal disease was associated with older age, being male in HIV-positive and HIV-negative participants. Moreover, HIV-positive adults reported poorer OHRQoL than HIV-negative counterparties. Furthermore, qualitative results revealed individual and external levels factors of oral disease and emphasized the physical/ functional, psychological and social effects of oral diseases on quality of life. Therefore, there is a need for effective oral health interventions specific to HIV-positive persons in Rwanda. The interventions should also raise awareness of the risk of common oral diseases (such as dental caries, and periodontal disease) and provide preventive oral health services among the Rwandan population, especially HIV-positive individuals. There is a need for a collaborative effort to establish programmes for regular and timely screening and management of periodontal disease and dental caries among the general population and specifically, HIV-positive individuals in Rwanda. To ensure timely oral health care among HIV- positive Rwandans, this study provides baseline data to aid policymakers and stakeholders to integrate oral health care services within HIV treatment programmes in R