|Year : 2015 | Volume
| Issue : 2 | Page : 148-151
Oral health-related quality of life among HIV patients at antiretroviral therapy center government hospital, Jaipur
N Anup, Mona Sikka, Gautam Biswas, G Shravani, Prateek Jain, Priyanka Sontakke
Department of Public Health Dentistry, Jaipur Dental College, Jaipur, Rajasthan, India
|Date of Web Publication||18-Jun-2015|
Department of Public Health Dentistry, Jaipur Dental College, Dhand, Jaipur Delhi Highway, NH 11 C, Jaipur - 302 028, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: According to center of disease control improving health outcomes of people living with HIV/acquired immunodeficiency syndrome (AIDS) is one of the key recommendations proposed in 2010 with an ultimate goal of extending life and improving its quality. Aims: The aim was to assess oral health-related quality of life among HIV/AIDS patients at antiretroviral therapy (ART) center government hospital, Jaipur. Materials and Methods: A total of 245 patients who attended out-patient department of ART center of government hospital, Jaipur were asked to participate, out of which 237 were agreed to participate. Sampling was done using simple random sampling a structured questionnaire (Cronbach α - 0.85) was used (oral health impact profile). Statistical Analysis Used: Paired t-test P = 0.05. Results: Males were more than females. 37% individuals showed difficulty in doing usual job. 41% showed that they were unable to work to full capacity, 22.4% said they had painful gums, and 19.4% said sleep was interrupted. Conclusions: Patients with more severe AIDS manifestations complained of a poorer status of oral symptoms, functional limitations, emotional and social well-being related to their oral health.
Keywords: Acquired immunodeficiency syndrome, HIV, oral health-related quality of life
|How to cite this article:|
Anup N, Sikka M, Biswas G, Shravani G, Jain P, Sontakke P. Oral health-related quality of life among HIV patients at antiretroviral therapy center government hospital, Jaipur. J Indian Assoc Public Health Dent 2015;13:148-51
|How to cite this URL:|
Anup N, Sikka M, Biswas G, Shravani G, Jain P, Sontakke P. Oral health-related quality of life among HIV patients at antiretroviral therapy center government hospital, Jaipur. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Jul 16];13:148-51. Available from: http://www.jiaphd.org/text.asp?2015/13/2/148/159051
| Introduction|| |
Since it was first recognized in early 1980s, the acquired immunodeficiency syndrome (AIDS) has been one of the most destructive diseases recorded in the world history. The devastating impact of HIV/AIDS on individual patient, family, community, and the nation is vast. The disease not only robs a country of its monetary resources in covering for the costs of HIV prevention and treatment, but also of the nation's human resources when young productive lives are affected. The 2010 statistics suggested that the overall growth of the disease has stabilized with declining number of new HIV cases since the last decade. However, the number of people living with HIV/AIDS (PLWHA) remained high and appeared to be still on the rise. 
According to the center of disease control (CDC) improving health outcomes of PLWHA is one of the key recommendations proposed in 2010 with an ultimate goal of extending life and improving its quality.  Oral health status of PLWHA was identified by World Health Organization (WHO) as an integral part of optimum case management. CDC recommendations were given to introduce surveillance activities of oral diseases associated with HIV infection in order to ensure appropriate medical evaluation, prevention and treatment. 
HIV/AIDS may lead to the development of various oral lesions. Several studies have demonstrated that 40-50% of HIV-positive individuals have fungal, bacterial or viral infections in the oral cavity that are likely to occur early. These oral lesions have physical, economic, social, and psychological consequences on the individuals and subsequent impairment of the oral health-related quality of life (OHR-QoL). 
Poor socioeconomic status, dental caries, reduced immunological response, painful symptoms in the mouth, decreased salivary function, and continuous use of medicines that have been formulated as syrups or sugared solutions are usual characteristics of patients with AIDS. , These patients frequently exhibit lesions on the oral mucosa, resulting in pain that contributes to ineffective or infrequent tooth brushing. Poor socioeconomic status, dental caries, reduced immunological response, painful symptoms in the mouth, decreased salivary function and continuous use of medicines of these conditions imply the risk of a prejudicial impact on oral health, and may affect the QoL.
Several knowledge attitude and practice studies have been carried out worldwide in relation to HIV/AIDS transmission and infection. ,,, , while scanty literature addressed the OHR-QoL among of PLWHA. The objective of this study was to assess the OHR-QoL among HIV/AIDS at the antiretroviral therapy (ART) center of government hospital, Jaipur.
| Materials and methods|| |
A total of 245 patients who attended out-patient department of ART center of government hospital, Jaipur were asked to participate, out of which 237 agreed to participate and met the criteria for AIDS case definition 6. Ethical approval was taken by the Ethical Committee of Institution and Government Medical College, Jaipur.
Pilot study was conducted prior to examination on 27 patients at ART center, government hospital, Jaipur. Sample size estimation was done using formula n = n = (z 2 * σ2 )/ME 2 (where n = sample size, ME = margin of error, σ =1 − confidence interval, Z = critical standard score). Sampling was done using simple random sampling.
- Patients with HIV
- CD4 cell count should be <350 cells/mm 3
- HIV duration should be 3-6 years.
About the questionnaire
- Patients who were psychologically compromised.
The purpose of the oral health impact profile (OHIP), is to provide a measure of the social impact of oral disorders and draws on a theoretical hierarchy of oral health outcomes. Validity and reliability of the questionnaire were checked on 27 patients with Cronbach's alpha value 0.85. The questionnaire was translated from English to Hindi language by the examiner. The questionnaire contained seven different dimensions (functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap). All these dimensions contained two questions each which define the OHR-QoL. Each question consisted of three options (Yes, No, Not Applicable).  In August 2014, the study was conducted at ART center of government hospital. The patients completed the questionnaire OHIP - 14.
T -test was used to compare the mean and SPSS 21.0 version (IBM Corp., Armonk, NY, USA) was used for analysis.
| Results|| |
In total of 237 patients, 92 were females and 145 were males. Mean was found in patient having sensitive teeth (12.45), patient with unsatisfactory diet (13.05), (18.8) in patients with difficulty in doing usual jobs, and (20.7) was found in patients with unable to work to full capacity [Table 1].
| Discussion|| |
Within the sample (237) of the study, it was found that majority of patients were males, similar findings reported by the Ministry of Health in Malaysia as males represented 93% of total cases infected with HIV/AIDS patients.  Patients were non-knowledgeable in relation to oral manifestations of the disease and one-third of the participating patients showed negative attitudes toward oral health care and reported various measures to manage oral lesions rather than seeking professional care.  However, little is known about the functional limitations, social, and psychological consequences of poor oral health among these patients.  Having assessed the self-perception of patients with AIDS, this study reported functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability, handicap that are associated with OHR-QoL general questions about self-perceived health are a useful resource that is commonly used in surveys. Endorsed by the WHO, this strategy permits the production of health indices that are related to several variables and contribute to an assessment of the demand and effective use of healthcare services. This proposition highlights the importance of including overall indices of oral health and well-being in the questionnaire used in this study. 
In general, the patients had sleep and dietary disturbances and also they were unable to work to their full capacity. In addition, the study group corresponds to one hospital and cannot be considered to be representative of a patient with AIDS. Therefore, this study strongly advocates the realization of further studies on OHR-QoL, with broader, and more representative samples of patients with AIDS. 
Knowledge of the extent of dental disease gives a clinical indication of the experience of dental problems, but it does not necessarily reflect the problems that people experience as a result of their dentition. There are differences between clinicians' and the public's evaluation of oral health. The capacity of dental clinicians and researchers to assess oral health and to advocate for dental care has been hampered by limitations in measurements of the levels of dysfunction, discomfort, and disability associated with oral disorders. The aim of this OHIP is to provide a comprehensive measure of self-reported dysfunction, discomfort, and disability arising from oral conditions. It is based on Locker's adaptation of the WHO classification of impairments, disabilities and handicaps. In the WHO model, impacts are organized linearly to move from a biological to a behavioral to a social level of analysis. Slade and Spencer adapted this by proposing seven dimensions of the impact of oral condition. Each of the seven dimensions in the original scale was assessed from questions on the type of problems experienced (a total of 49 questions). A shortened version (OHIP-14) was later developed based on a subset of two questions for each of the seven dimensions.  A study conducted by Dolar Doshi et al found that mean OHI-S score was higher among HIV positive females undergoing anti retroviral therapy. 
In India, social stigma and economical status lead the sufferer and his family in abject penury. highly active ART regimens may not be available or accessible to those in need, oral lesions thus remain as indispensable component of HIV infection  While there is continuing interest to investigate oral manifestations and immunologic responses among PLWHA, the study on OHR-QOL has emerged as an important focus in HIV research. The social impact of HIV-related oral lesions and other oral health problems is recognized as an important attribute used to assess the outcomes of oral health services, to assist in cost-benefit analysis, and to monitor individual patient care. Although to date, studies on the OHR-QOL among HIV-infected individuals are not many, the current available evidence suggested that the impact is substantial. At times, this leads to shunning by family and near and dear ones, broken homes, loss of employment, restricted options for marriage, employment, and may even lead to divorce even though the treatment is provided for free. It goes a long way in improving the QoL and adherence to the treatment for a lifetime of the patients.
| Conclusions|| |
It is imperative that health care providers, particularly oral health professionals, are able to identify the signs and symptoms of HIV-related oral lesions and recognize the significant role of these lesions in diagnosis and management of HIV infection. Patient with more severe AIDS manifestation complained of functional limitations, emotional, and social well-being related to their oral health. This study's findings highlight the need to integrate the dentist in the interdisciplinary health care team that assists patients with AIDS, and can instruct health programs that are intended to improve their overall QoL.
| References|| |
Saddki N, Mohamad WM. Oral health-related quality of life among people living with HIV/AIDS. Trans R Soc Trop Med Hyg 1997:91-6.
Centers for Disease Control and Prevention (CDC). Vital signs: HIV prevention through care and treatment - United States. MMWR Morb Mortal Wkly Rep 2011;60:1618-23.
Petersen PE. Strengthening the prevention of HIV/AIDS-related oral disease: A global approach. Community Dent Oral Epidemiol 2004;32:399-401.
Bajomo AS. The impact of oral manifestations of HIV/AIDS on quality of life of patients living with HIV/AIDS: South African division, IADR. J Dent Res 2004;83:20-24 .
Waldman HB. Almost eleven million special children. ASDC J Dent Child 1991;58:237-40.
Centers for Disease Control and Prevention. Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Morb Mortal Wkly Rep 1994;43:1-10.
Adelekan ML, Jolayemi SO, Ndom RJ, Adegboye J, Babatunde S, Tunde-Ayimode M, et al.
Caring for people with AIDS in a Nigerian teaching hospital: Staff attitudes and knowledge. AIDS Care 1995;7 Suppl 1:S63-72.
Li-Zhen Y. KAP about AIDS among college students and relevant health education strategies. Chin J Health Educ 2004;2:52-6.
Rahlenbeck SI. Knowledge, attitude, and practice about AIDS and condom utilization among health workers in Rwanda. J Assoc Nurses AIDS Care 2004;15:56-61.
Xiu C, Jiang Z, Chu Q, Wang Z, Fa P, Hao B, et al
. KAP about AIDS among prisoners and relevant intervention. Chin J Health Educ 2004;11:711-20.
Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994;11:3-11.
MDG6 Combat HIV/AIDS, Malaria and Other Diseases. Available from: http://www.undp.my/uploads/mdg6.pdf. [Last cited on 2014 Sep 11].
Fine DH, Tofsky N, Nelson EM, Schoen D, Barasch A. Clinical implications of the oral manifestations of HIV infection in children. Dent Clin North Am 2003;47:159-74, xi-xii.
Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, et al
. Adult Dental Health Survey - Oral Health in the United Kingdom 1998. London: The Stationery Office; 2000.
Uith; January, 2001. Available from: http://www.dundee.ac.uk/tuith/Articles/rt04b3.htm. [Last cited on 2014 Sep 17].
Doshi D, Rampuram J. Anup N. Periodontal status of HIV-positive patients; Med Oral Patol cir bucal; 2009;1;14(g);e384-7