Oral lesions among HIV-infected children on antiretroviral treatment in West Africa

Objective To estimate the prevalence of oral mucosal diseases and dental caries among HIV-infected children receiving antiretroviral treatment (ART) in West Africa and to identify the factors associated with the prevalence of oral mucosal lesions. Methods Multicentre cross-sectional survey in five paediatric HIV clinics in Cote d'Ivoire, Mali and Senegal. A standardised examination was performed by trained dentists on a random sample of HIV-infected children aged 5-15years receiving ART. The prevalence of oral and dental lesions and mean number of decayed, missing/extracted and filled teeth (DMFdefT) in temporary and permanent dentition were estimated with their 95% confidence interval (95% CI). We used logistic regression to explore the association between children's characteristics and the prevalence of oral mucosal lesions, expressed as prevalence odds ratio (POR). Results The median age of the 420 children (47% females) enrolled was 10.4years [interquartile range (IQR)=8.3-12.6]. The median duration on ART was 4.6years (IQR=2.6-6.2); 84 (20.0%) had CD4 count<350cells/mm(3). A total of 35 children (8.3%; 95% CI: 6.1-11.1) exhibited 42 oral mucosal lesions (24 were candidiasis); 86.0% (95% CI=82.6-89.3) of children had DMFdefT1. The presence of oral mucosal lesions was independently associated with CD4 count<350cells/mm(3) (POR=2.96, 95% CI=1.06-4.36) and poor oral hygiene (POR=2.69, 95% CI=1.07-6.76). Conclusions Oral mucosal lesions still occur in HIV-infected African children despite ART, but rarely. However, dental caries were common and severe in this population, reflecting the need to include oral health in the comprehensive care of HIV.