| HIV disease is associated with oral manifestations that range from ulcerative conditions to lesions with fungal, bacterial, or viral etiology or even neoplasms. The aim of this dissertation is to explore two main aspects of HIV disease in relation to oral health: in the first part I examine various risk factors that may contribute to the occurrence of HIV-related oral conditions. I present secondary analyses conducted on data from several cohort studies of HIV-infected adults in San Francisco. In particular, in the first investigation I explore the hypothesis of a gender difference with respect to HIV-related oral conditions in three cohorts of women and men. Hairy leukoplakia and candidiasis are the most common oral lesions found in this group of 200 men and 218 women followed at 6-month intervals for 4 years. I use a marginal regression model (generalized estimating equation) to show that men are more likely to have hairy leukoplakia than women, after controlling for CD4 count, race, and injection drug use. The objective of the second investigation described in Part I is to examine if an association exists between oral sex practices and hairy leukoplakia (an Epstein Barr virus-associated oral lesion). Using survival analysis I find no association between the number of receptive oral sex male partners and the occurrence of hairy leukoplakia among 291 HIV-infected homosexual/bisexual men followed at 6-month intervals for 6 years. Incidentally, the analysis reveals that the hazard of developing hairy leukoplakia is twice as high in smokers as in non smokers, controlling for CD4 count.; Part II addresses the issue of access to dental care in HIV-infected women. My main objective is to identify predictors of dental care utilization in this population. The cross-sectional survey that I conducted in a sample of 213 HN-infected women in the San Francisco Bay area reveals low use of preventive dental care, a high percentage of edentulism, and high level of unmet dental need, although two thirds of the women have dental insurance through a State assistance program. Fear of dentists and low motivation are important barriers to dental care utilization in this group. |
