Study On Oral Health, Salivary HBD-2,3Expression And CD4+T Lymphocyte Count Of Hiv/Aids Patients Undergoing Haart

Objectives:This study aimed to investigate the dynamic changes of oral manifestation, oral candidal carriage as well as the immunity status of HIV/AIDS patients undergoing HAART, to explore the relationships between salivary hBDs and oral candidal carriage, and their relationships with blood CD4+T lymphocyte count, to understand the role of human (3defensins in the oral innate immunity among HIV/AIDS patients.Methods:23HIV/AIDS patients ready for HAART were included in this study for6months followup. Informations were recorded for baseline and3month,6month with HAART, including medical history, oral examinations. Unstimulated whole saliva, oral rinse, peripheral blood samples were collected for further study. Saliva flow rate, salivary pH value, oral candidal carriage and biotypes were tested. CD4+T lymphocyte count was detected by flow cytometry method. hBD-2,3were detected by ELISA.31age and gender matched healthy individuals were included for the healthy control. The statistical analysis was performed using Statistical Programme for Social Sciences (SPSS)13.0for windows. Repeated measure ANOVA, Independent two-sample t test, Wilcoxon rank sum test,Pearson and Spearman correction analyze were used.Results:1. The mean CD4+T lymphocyte count at HAART baseline,3th month,6th month was212.17±130.24cells/mm3,300.35±149.85cells/mm3,308.52±159.21cells/mm3respectively, which had statistic significance (P＜0.05). CD4+T lymphocyte count of HIV/AIDS patients in each period was significantly lower than the control group (P<0.05).2. At the baseline oral manifestations were diagnosed among14out of23HIV/AIDS patients, including6patients with oral hairy leukoplakia,5with candidiosis,2with oral ulcer,2with oral leukoplakia,1with xerostomia,1with burning mouth syndrome, among which2patients with oral candidiosis and oral hairy leukoplakia combined,1patient with oral candidiosis and oral leukoplakia combined. Oral lesions healed or improved to certain degree6months after HAART. Oral manifestation was found to be significantly correlated to the reduced CD4+cell count (P<0.05). The mean CD4+T lymphocyte count of patients with and without oral manifestation is154.71±136.98cells/mm3,301.56±clls/mm3.There was no corelation between oral manifestation and age as well as gender.3. The carriage of candida decreased among the HAART (P<0.05). The frequency of oral candidal carriage was greater in patients infected with HIV/AIDS (82.61%) than the control group (51.61%), P<0.05. Candida albicans was the most commonly Candida species isolated from HIV/AIDS patients and the control group. The positive culture rates showed statistic difference for both groups (P<0.05). There was statistic significance in the positive culture rate of Candida albicans between HIV/AIDS at baseline,6th month and healthy control. Meanwhile, positive culture rates of Candida glabrata, Candida tropicalis, Candida krusei showed statistic difference for both groups in all stages (P<0.05). The ratios of patients with two more coexisted species of candida in the three stages were42.1%,26.3%,68.32%respectively.4. There was no statistic significance of salivary pH value among the HAART baseline,3th month,6th month, but the flow rate of unstimulated whole saliva, which were0.52±0.28ml/min,0.68±0.31ml/min,0.82±0.34ml/min respectively, showed statistic significance (p<0.05). The mean concentrations of salivary hBD-2and hBD-3among HAART were16.546±26.974ng/ml,5.564±3.179ng/ml,4.958±4.291ng/ml and0.939±1.163ng/ml,1.135±2.057ng/ml,0.790±0.779ng/ml respectively. There was statistic significance of hBD-2expression (P<0.05), and no significance was observed in salivary hBD-3of the three periods (P>0.05).5. There was no statistic significance for the CD4+T lymphocyte between asymptomatic carriage higher than300CFU/ml and lower than300CFU/ml and no statistic significance between asymptomatic oral candidal load and CD4+T lymphocyte count (P>0.05). There was negative correlation between the candidal load and flow rate of UWS (P=0.003, r=-0.357). And no significant differences were observed between candidal load and pH or hBD-3expression.Conclusion:HIV/AIDS patients had obvious oral manifestation especially OC and OHL. The hyposecrection of saliva might increase the risk of oral candidal colonization contributing to the oral candidiosis. Salivary hBD-2and hBD3might play an important role on protection of oral cavity against candidal infection.