AIDS, HIV Infection, and Related Conditions

Definition

On June 5, 1981, when the Centers for Disease Control and Prevention (CDC) reported five cases of Pneumocystis carinii (now jiroveci ) pneumonia in young homosexual men in Los Angeles, few suspected that it heralded a pandemic of acquired immunodeficiency syndrome (AIDS). In 1983, a retrovirus (later named the human immunodeficiency virus [HIV]) was isolated from a patient with AIDS. Since that first report, more than 70 million persons have been infected with HIV, and more than 30 million have died of AIDS. The total number of deaths has exceeded those caused by the Black Death of 14th-century Europe and the influenza pandemic of 1918 and 1919. About 95% of HIV-infected persons live in low- to middle-income regions and countries and in sub-Saharan Africa. More than 40% of new infections (excluding those in infants) occur in young people 15 to 24 years of age.

AIDS is an infectious disease caused by HIV, which is transmitted predominantly through intimate sexual contact and by parenteral means. In view of the nature of this bloodborne pathogen, HIV infection and AIDS have important implications for dental practitioners. Although HIV has rarely been transmitted from patients to health care workers, this may occur, and patients with HIV infection or AIDS may be medically compromised and may need special dental management considerations. On the basis of current statistics, the average dental practice is predicted to encounter at least two patients infected with HIV per year.

The definition of AIDS provided by the CDC has been revised several times over the years, and in 2008, it was revised to be laboratory-confirmed evidence of HIV infection in a person who has stage 3 HIV infection (i.e., a CD4+ lymphocyte count <200 cells/µL). This definition also includes HIV-infected persons whose CD4+ count may be above 200/µL but have an AIDS-defining condition, as shown in Box 18.1 . Of note, because of the provision of antiretroviral drug regimens, not all patients progress to AIDS or develop life-threatening opportunistic infections.

Box 18.1
AIDS-Defining Conditions

  • Bacterial infections, multiple or recurrent *

    * Only among children younger than 13 years of age. (Data from Centers for Disease Control and Prevention: 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age, MMWR Recomm Rep 43:1, 1994 and Centers for Disease Control and Prevention: 2008 revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, MMWR Recomm Rep 57:9, 2008.)

  • Candidiasis of bronchi, trachea, or lungs

  • Candidiasis of esophagus

    Condition that might be diagnosed presumptively.

  • Cervical cancer, invasive

    Only among adults and adolescents 13 years of age and older. (Data from Centers for Disease Control and Prevention: 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults, MMWR Recomm Rep 41:1, 1993.)

  • Coccidioidomycosis, disseminated or extrapulmonary

  • Cryptococcosis, extrapulmonary

  • Cryptosporidiosis, chronic intestinal (>1 month in duration)

  • Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month

  • Cytomegalovirus retinitis (with loss of vision)

  • Encephalopathy, HIV related

  • Herpes simplex: chronic ulcers (>1 month’s duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month)

  • Histoplasmosis, disseminated or extrapulmonary

  • Isosporiasis, chronic intestinal (>1 month’s duration)

  • Kaposi sarcoma

  • Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex *

  • Lymphoma, Burkitt (or equivalent term)

  • Lymphoma, immunoblastic (or equivalent term)

  • Lymphoma, primary, of brain

  • Mycobacterium avium complex or Mycobacterium kansasii infection, disseminated or extrapulmonary

  • Mycobacterium tuberculosis infection of any site, pulmonary, disseminated, or extrapulmonary

  • Mycobacterium infection, other species or unidentified species, disseminated or extrapulmonary

  • Pneumocystis jiroveci pneumonia

  • Pneumonia, recurrent

  • Progressive multifocal leukoencephalopathy

  • Salmonella septicemia, recurrent

  • Toxoplasmosis of brain, onset at age >1 month

  • Wasting syndrome attributed to HIV

CRITICAL COMPLICATIONS: Patients with HIV/AIDS undergoing dental treatment may not be diagnosed and may be at risk for either transmitting the infection or sustaining complications such as infection, bleeding, drug interactions, and side effects. These events could prove serious. Dentists must be able to identify these patients, assess risk based on history and clinical findings, and work closely with the managing physician to develop a dental management plan that will be effective and safe for the patient as well as others.

Incidence and Prevalence

An estimated 2.7 million people across the globe are newly infected with HIV annually.

Since the onset of the worldwide pandemic, more than 70,000,000 people have been infected with HIV, of whom approximately 35,000,000 have died as a consequence of AIDS ( Tables 18.1 and 18.2 ). HIV prevention efforts have been “front and center” since the virus was discovered as the cause of AIDS, and behavioral interventions focused on HIV-negative persons have likely played a role in the falling population level incidence in some countries reported by the United Nations Program in HIV/AIDS (UNAIDS) in its 2012 report.

TABLE 18.1
Select Patient Characteristics in HIV Infection
2010 2011 2012 2013 2014
Estimated * Estimated * Estimated * Estimated * Estimated *
No. No. Rate No. No. Rate No. No. Rate No. No. Rate No. No. Rate
AGE AT DIAGNOSIS (YR)
<13 232 238 0.4 192 198 0.4 240 250 0.5 180 191 0.4 159 174 0.3
13–14 42 43 0.5 43 45 0.5 44 46 0.6 40 43 0.5 33 35 0.4
15–19 2071 2118 9.6 2002 2068 9.5 1875 1964 9.2 1689 1792 8.5 1664 1828 8.7
20–24 7079 7245 33.4 7069 7311 33.0 7157 7489 33.1 7035 7483 32.7 7144 7868 34.3
25–29 6366 6520 30.8 6346 6563 30.8 6470 6777 31.7 6711 7151 33.1 7114 7870 35.8
30–34 5504 5639 28.1 5272 5455 26.6 5472 5729 27.4 5235 5574 26.2 5449 6026 28.0
35–39 5046 5171 25.8 4463 4622 23.6 4176 4374 22.4 4031 4288 21.8 4212 4662 23.4
40–44 5230 5361 25.6 4800 4971 23.6 4433 4646 22.1 3997 4257 20.4 3799 4196 20.4
45–49 4851 4972 22.0 4595 4758 21.5 4317 4527 20.8 3995 4268 20.1 3647 4021 19.3
50–54 3510 3602 16.1 3364 3487 15.4 3219 3377 14.9 3024 3235 14.3 2928 3242 14.4
55–59 2077 2132 10.8 1999 2072 10.2 1923 2019 9.7 2047 2184 10.3 1949 2166 10.1
60–64 1064 1091 6.4 1072 1111 6.2 1052 1106 6.2 1098 1170 6.5 960 1069 5.8
≥65 790 810 2.0 816 848 2.0 819 861 2.0 867 930 2.1 819 914 2.0
RACE/ETHNICITY
American Indian or Alaska Native 174 177 7.8 159 163 7.1 187 193 8.4 178 186 8.0 208 222 9.5
Asian 708 727 4.9 774 802 5.3 809 848 5.4 809 859 5.3 941 1046 6.2
Black or African American 20,461 20,987 55.2 19,345 20,064 52.3 18,632 19,581 50.5 17,993 19,252 49.2 17,592 19,540 49.4
Hispanic or Latino 9072 9291 18.3 8919 9230 17.8 8954 9372 17.7 8829 9386 17.3 9227 10,201 18.4
Native Hawaiian or other Pacific Islander 57 58 11.7 56 58 11.4 58 60 11.6 54 56 10.6 53 58 10.6
White 11,864 12,135 6.1 11,376 11,738 5.9 11,259 11,752 5.9 10,914 11,581 5.9 10,967 12,025 6.1
Multiple races 1526 1565 27.7 1404 1456 25.0 1298 1358 22.6 1172 1246 20.1 889 982 15.4
TRANSMISSION CATEGORY
Male Adult or Adolescent
Male-to-male sexual contact 21,834 27,034 21,828 27,001 21,758 27,588 21,594 27,642 21,566 29,418
Injection drug use 1307 2115 1080 1819 916 1642 874 1575 809 1590
Male-to-male sexual contact and injection drug use 1238 1562 1100 1393 1036 1342 924 1216 870 1217
Heterosexual contact 2891 4111 2739 3683 2500 3617 2398 3545 2049 3285
Other § 6771 52 6245 50 6491 69 6163 57 6891 60
Subtotal 34,041 34,871 27.9 32,992 34,146 27.0 32,701 34,259 26.9 31,953 34,034 26.4 32,185 35,571 27.4
Female Adult or Adolescent
Injection drug use 803 1455 672 1284 617 1178 559 1073 495 1045
Heterosexual contact 4740 8340 4307 7833 3905 7439 3782 7213 3282 7242
Other § 4046 36 3870 49 3734 39 3475 55 3756 41
Subtotal 9589 9831 7.5 8849 9166 6.9 8256 8656 6.5 7816 8340 6.2 7533 8328 6.1
Child (<13 yr at Diagnosis)
Perinatal 181 185 142 147 168 175 119 127 115 127
Other 51 53 50 51 72 75 61 64 44 48
Subtotal 232 238 0.4 192 198 0.4 240 250 0.5 180 191 0.4 159 174 0.3
REGION OF RESIDENCE
Northeast 8381 8597 15.5 7800 8087 14.5 7646 8039 14.4 7236 7750 13.8 7137 7953 14.2
Midwest 5554 5664 8.5 5424 5580 8.3 5507 5717 8.5 5376 5654 8.4 5099 5529 8.2
South 21,997 22,550 19.6 21,316 22,079 19.0 20,469 21,480 18.3 20,131 21,508 18.1 20,065 22,196 18.5
West 7930 8129 11.3 7493 7764 10.7 7575 7929 10.8 7206 7654 10.3 7576 8395 11.2
Total 43,862 44,940 14.5 42,033 43,510 14.0 41,197 43,165 13.7 39,949 42,566 13.4 39,877 44,073 13.8
Note . Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis.

* Estimated numbers resulted from statistical adjustment that accounted for reporting delays and missing transmission category but not for incomplete reporting. Rates are per 100,000 population. Rates are not calculated by transmission category because of the lack of denominator data.

Hispanics and Latinos can be of any race.

Heterosexual contact with a person known to have or to be at high risk for HIV infection.

§ Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

Includes hemophilia, blood transfusion, and risk factor not reported or not identified.

Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

TABLE 18.2
Select Patient Characteristics in AIDS
2010 2011 2012 2013 2014
Estimated * Estimated * Estimated * Estimated * Estimated * Cumulative
No. No. Rate No. No. Rate No. No. Rate No. No. Rate No. No. Rate No. Est. No. *
AGE AT DIAGNOSIS (YR)
<13c 21 21 0.0 15 15 0.0 10 10 0.0 8 8 0.0 94 104 0.2 9561 9588
13–14 49 50 0.6 40 42 0.5 30 31 0.4 28 30 0.4 20 22 0.3 1462 1477
15–19 451 461 2.1 426 440 2.0 349 363 1.7 401 423 2.0 207 227 1.1 8909 9027
20–24 1989 2038 9.4 1970 2042 9.2 1895 1981 8.8 2001 2112 9.2 1339 1467 6.4 51,371 51,986
25–29 2886 2956 14.0 2776 2877 13.5 2730 2853 13.3 2809 2974 13.8 2303 2531 11.5 141,002 142,069
30–34 3305 3382 16.9 3133 3242 15.8 3236 3377 16.1 2931 3099 14.6 2368 2598 12.1 224,940 226,254
35–39 3717 3804 18.9 3205 3318 16.9 2919 3047 15.6 2848 3010 15.3 2330 2556 12.8 243,597 245,042
40–44 4324 4425 21.2 3776 3909 18.6 3431 3577 17.0 3095 3270 15.7 2424 2659 12.9 204,493 205,990
45–49 4292 4392 19.4 3965 4107 18.5 3650 3805 17.5 3344 3534 16.6 2611 2866 13.7 139,973 141,345
50–54 3168 3240 14.5 2908 3009 13.3 2888 3010 13.3 2807 2963 13.1 2253 2468 10.9 83,736 84,738
55–59 1761 1801 9.1 1802 1863 9.2 1771 1848 8.9 1796 1893 8.9 1548 1702 7.9 46,497 47,105
60–64 936 957 5.6 906 936 5.3 991 1033 5.8 1031 1087 6.0 835 913 4.9 24,762 25,078
≥65 742 759 1.9 721 744 1.8 722 751 1.7 769 811 1.8 713 784 1.7 20,882 21,137
RACE/ETHNICITY
American Indian or Alaska Native 116 118 5.2 103 105 4.6 94 96 4.2 91 94 4.0 90 95 4.0 3498 3523
Asian § 363 372 2.5 362 375 2.5 354 369 2.3 358 379 2.3 323 352 2.1 9689 9815
Black or African American 13,419 13,745 36.2 12,363 12,816 33.4 12,030 12,574 32.4 11,548 12,219 31.2 9119 10,045 25.4 499,734 504,354
Hispanic or Latino 5617 5745 11.3 5237 5415 10.4 5015 5222 9.8 4868 5132 9.5 3924 4279 7.7 217,650 219,578
Native Hawaiian or other Pacific Islander 39 40 8.0 31 32 6.3 26 27 5.2 27 28 5.2 18 19 3.5 842 850
White 6953 7102 3.6 6483 6693 3.4 6111 6354 3.2 6005 6328 3.2 4850 5303 2.7 436,952 439,455
Multiple races 1134 1165 20.6 1064 1108 19.0 992 1044 17.4 971 1034 16.7 721 803 12.6 32,820 33,260
TRANSMISSION CATEGORY
Male Adult or Adolescent
Male-to-male sexual contact 11,695 14,448 11,238 13,863 10,826 13,664 10,781 13,785 8,180 11,277 529,245 586,385
Injection drug use 1485 2072 1240 1773 1116 1649 957 1477 812 1268 165,386 187,372
Male-to-male sexual contact and injection drug use 1177 1431 1018 1242 929 1166 774 1005 555 782 78,824 85,290
Heterosexual contact 2255 3092 2112 2896 1946 2728 1891 2730 1453 2211 66,501 84,200
Other ** 4063 118 3613 127 3699 117 3696 133 3,243 85 107,624 11,627
Subtotal 20,675 21,161 16.9 19,221 19,901 15.8 18,516 19,324 15.2 18,099 19,130 14.9 14,243 15,624 12.0 947,580 954,875
Female Adult or Adolescent
Injection drug use 981 1469 864 1302 781 1205 671 1089 523 913 75,745 90,413
Heterosexual contact 3603 5502 3316 5195 3113 5039 2899 4839 2203 4150 114,383 149,980
Other ** 2361 133 2227 131 2202 109 2191 147 1982 106 53,916 5979
Subtotal 6945 7105 5.4 6407 6628 5.0 6096 6353 4.8 5761 6075 4.5 4708 5168 3.8 244,044 246,372
Child (<13 Yr at Diagnosis)
Perinatal 15 15 12 12 8 8 8 8 83 92 8690 8715
Other †† 6 6 3 3 2 2 0 0 11 12 871 874
Subtotal 21 21 0.0 15 15 0.0 10 10 0.0 8 8 0.0 94 104 0.2 9561 9588
REGION OF RESIDENCE ‡‡
Northeast 5631 5782 10.4 5153 5356 9.6 4765 4992 8.9 4360 4636 8.3 3409 3793 6.8 351,863 354,392
Midwest 3365 3431 5.1 3248 3341 5.0 3106 3215 4.8 2952 3087 4.6 2431 2627 3.9 127,677 128,670
South 13,747 14,059 12.2 12,949 13,402 11.5 12,608 13,155 11.2 12,667 13,376 11.3 10,003 10,965 9.2 483,173 487,539
West 4898 5016 7.0 4293 4445 6.1 4143 4325 5.9 3889 4115 5.5 3202 3511 4.7 238,472 240,235
Total 27,641 28,287 9.1 25,643 26,545 8.5 24,622 25,687 8.2 23,868 25,214 8.0 19,045 20,896 6.6 1,201,185 1,210,835
Note . Reported numbers less than 12, as well as estimated numbers (and accompanying rates and trends) based on these numbers, should be interpreted with caution because the numbers have underlying relative standard errors greater than 30% and are considered unreliable.
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Sep 3, 2018 | Posted by in General Dentistry | Comments Off on AIDS, HIV Infection, and Related Conditions
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