Infectious Diseases: Human Immunodeficiency Virus (HIV) and AIDS
Journal Article Summary
Journal Title: "Oral Lesions, HIV Phenotypes, and Management of HIV-Related Disease: Workshop 4A"
Summary: This article discusses a workshop done in which five questions "related to oral lesions, HIV phenotypes, and the management of HIV-related disease, with a focus on evidence and challenges in resource-poor settings". The following are the questions that were addressed, along with brief summaries of the conclusions that were made.
1) Are oral lesions unique with respect to geographic location or phenotype? The classification of oral disease among the globe is very complex. Although there may be patterns that are seen in varying populations, it is not certain that the differences seen are related to the "HIV type distribution or to regional differences in prevalence of etiologic agents and other predisposing factors" (Patton et al., 2011). Oral lesions such as Kaposi sarcoma, oral hairy leukoplakia, hyperpigmentation and HIV salivary gland disease have been identified predominately in certain locations, however it is still unsure if this is due to specific HIV phenotypes or other predisposing factors in the specific locations.
2) How useful would an oral lesion index be to predict HIV in resource-poor countries with no access to CD4 counts or viral load? The majorities of individuals that have HIV/AIDS have had or will have at least one oral lesion at some stage of their disease. Developing such an index would be very difficult, including many different factors. However, if an accurate, easy-to-use screening tool were available to use in resource-poor countries, it would aid in identification/screenings and prevention efforts. The use of such an index is controversial, "but the potential benefits make it an area worth addressing" (Patton et al., 2011). Oral lesions are identifiable by the oral health care worker such as a dental hygienist and the identification of such lesions can lead to early intervention and treatment for these immunocompromised individuals.
3) What are the latest methods and delivery modes for drugs used to treat oral lesions associated with HIV? In resource-poor countries, the use of inexpensive topical therapies to manage oral candidiasis (the most common oral lesion in HIV/AIDS) such as tea tree oil, "chlorhexidine, providone iodine, and gentian violet" (Patton et al., 2011) have been proposed to manage oral candidiasis. The article continues to mention some studies that were done to test the effectiveness of these remedies, all of which showed great results.
4) What is the role of the oral health care worker in rapid diagnostic testing for HIV? There are a variety of rapid HIV diagnostic tests available for "use on saliva and oral mucosal transudate...with consistent sensitivity and specificity ratings at or near 100%" (Patton et al., 2011). These rapid tests are useful to detect antibodies to HIV and must be confirmed with further diagnostic testing such as the western blot or immunofluorescent assay. A pilot study done in 2007 in Kansas City, Missouri, 73% of urban free dental clinic patients said that they would be willing to take this free test during their appointment. This type of diagnostic testing is still controversial and many factors are being considered with whether or not this may become a role of the oral health care worker. It is very important that oral health care workers are properly trained and actively involved in the screening and detection of oral lesions. Communication between the oral health care worker and the primary care physician of the HIV/AIDS-positive individual is very important; together, they must work as a team to provide the best possible care for these patients.
5) What ethical and legal issues are to be considered when managing the HIV patient? HIV/AIDS is an infectious disease that has challenged the ethical values of health care professionals because of an unfortunate associated stigma and discrimination. Legal dilemmas have been managed with "great sensitivity pertaining to informed consent, confidentiality, and disclosure" (Patton et al., 2011). In countries that are relatively diverse, cultural differences must also be taken in to consideration. Patients infected with HIV/AIDS have the right to privacy about their condition just like any other patient that is being treated by you. Some clinical information must be shared amongst other health care workers; however information is not to be shared out of a professional setting. Such violations of privacy can lead to ethical and legal issues.
This article continued to discuss the treatment of HIV/AIDS patients in the dental setting. There is no need to modify dental care for patients that are infected with this disease because the use of standard precautions should be enforced in the treatment of any/all patients. In doing so, the risk of disease transmission in dentistry is rare. Treating an HIV/AIDS individual should not be an issue, just as though a dental professional would not discriminate against the race, sexual identity, culture, etc. of an individual. Oral health care workers are often the first to identify oral manifestations of HIV/AIDS in patients who otherwise may be unaware to being infected with HIV. Communication with the patient is essential for early detection. This will help in dental hygiene care, because we as hygienists, are responsible for being able to identify abnormalities and lesions in the oral cavity. It is important to be able to notice slight variations from normal because early detection is critical, especially in autoimmune diseases that can progress very rapidly.
Personal Reflection: I chose to find an article on HIV/AIDS, primarily because of the lecture received in class, but also because of a patient that I knew from working at my previous dental office that was a victim of AIDS. Being around this patient was my first time being around an individual (that I knew of) that had AIDS. I remember thinking to myself that I was grateful that this patient was honest about marking this on his medical history. At first, when I saw that HIV/AIDS was checked "yes", I too was a little nervous to be assisting in providing dental treatment to him. As we discussed in class, there is a stigma that is unfortunately associated with individuals that are affected by this disease which causes them to shy away from being able to openly discuss their illness. It is disturbing to me that individuals that have a disease can be treated in a very unethical way. I have since realized that my nervousness at the time was due to a lack of knowledge about the disease. I am thankful for the education that I have received and hope to educate others and stop some of the stigma's that are so quickly placed on individuals suffering from disease. I enjoyed this journal article because of its incorporation of HIV/AIDS treatment and prevention not only in the United States, but also in other undeveloped areas. I now know first hand that education plays a huge role in how individuals with HIV/AIDS are treated. I really liked that there was an emphasis on the detection of lesions in the oral cavity because as I become a dental hygienist, it is my responsibility to be aware of oral lesions that can affect the life of an individual. Early detection leads to early treatment which is crucial in immunocompromised individuals.
Citation:
Patton, L., Ranganathan, K., Naidoo, S., Bhayat, A., Balasundaram, S., Adeyemi, O., & ... Chandra, L. (2011). Oral
lesions, HIV phenotypes, and management of HIV-related disease: Workshop 4A. Advances In Dental Research, 23(1),
112-116.
Additional Information:
http://www.actagainstaids.org/index.html Act Against AIDS is a national campaign that was launched by the Centers for Disease Control and Prevention (CDC) and the White House in 2009 that focuses on raising awareness among all Americans and reducing the risk of infection among individuals that are at high risk.
http://www.aids.org/ This is a very informational website that has a lot of current HIV/AIDS news articles that are very interesting.
**Images retrieved from google.com/images**
Summary: This article discusses a workshop done in which five questions "related to oral lesions, HIV phenotypes, and the management of HIV-related disease, with a focus on evidence and challenges in resource-poor settings". The following are the questions that were addressed, along with brief summaries of the conclusions that were made.
1) Are oral lesions unique with respect to geographic location or phenotype? The classification of oral disease among the globe is very complex. Although there may be patterns that are seen in varying populations, it is not certain that the differences seen are related to the "HIV type distribution or to regional differences in prevalence of etiologic agents and other predisposing factors" (Patton et al., 2011). Oral lesions such as Kaposi sarcoma, oral hairy leukoplakia, hyperpigmentation and HIV salivary gland disease have been identified predominately in certain locations, however it is still unsure if this is due to specific HIV phenotypes or other predisposing factors in the specific locations.
2) How useful would an oral lesion index be to predict HIV in resource-poor countries with no access to CD4 counts or viral load? The majorities of individuals that have HIV/AIDS have had or will have at least one oral lesion at some stage of their disease. Developing such an index would be very difficult, including many different factors. However, if an accurate, easy-to-use screening tool were available to use in resource-poor countries, it would aid in identification/screenings and prevention efforts. The use of such an index is controversial, "but the potential benefits make it an area worth addressing" (Patton et al., 2011). Oral lesions are identifiable by the oral health care worker such as a dental hygienist and the identification of such lesions can lead to early intervention and treatment for these immunocompromised individuals.
3) What are the latest methods and delivery modes for drugs used to treat oral lesions associated with HIV? In resource-poor countries, the use of inexpensive topical therapies to manage oral candidiasis (the most common oral lesion in HIV/AIDS) such as tea tree oil, "chlorhexidine, providone iodine, and gentian violet" (Patton et al., 2011) have been proposed to manage oral candidiasis. The article continues to mention some studies that were done to test the effectiveness of these remedies, all of which showed great results.
4) What is the role of the oral health care worker in rapid diagnostic testing for HIV? There are a variety of rapid HIV diagnostic tests available for "use on saliva and oral mucosal transudate...with consistent sensitivity and specificity ratings at or near 100%" (Patton et al., 2011). These rapid tests are useful to detect antibodies to HIV and must be confirmed with further diagnostic testing such as the western blot or immunofluorescent assay. A pilot study done in 2007 in Kansas City, Missouri, 73% of urban free dental clinic patients said that they would be willing to take this free test during their appointment. This type of diagnostic testing is still controversial and many factors are being considered with whether or not this may become a role of the oral health care worker. It is very important that oral health care workers are properly trained and actively involved in the screening and detection of oral lesions. Communication between the oral health care worker and the primary care physician of the HIV/AIDS-positive individual is very important; together, they must work as a team to provide the best possible care for these patients.
5) What ethical and legal issues are to be considered when managing the HIV patient? HIV/AIDS is an infectious disease that has challenged the ethical values of health care professionals because of an unfortunate associated stigma and discrimination. Legal dilemmas have been managed with "great sensitivity pertaining to informed consent, confidentiality, and disclosure" (Patton et al., 2011). In countries that are relatively diverse, cultural differences must also be taken in to consideration. Patients infected with HIV/AIDS have the right to privacy about their condition just like any other patient that is being treated by you. Some clinical information must be shared amongst other health care workers; however information is not to be shared out of a professional setting. Such violations of privacy can lead to ethical and legal issues.
This article continued to discuss the treatment of HIV/AIDS patients in the dental setting. There is no need to modify dental care for patients that are infected with this disease because the use of standard precautions should be enforced in the treatment of any/all patients. In doing so, the risk of disease transmission in dentistry is rare. Treating an HIV/AIDS individual should not be an issue, just as though a dental professional would not discriminate against the race, sexual identity, culture, etc. of an individual. Oral health care workers are often the first to identify oral manifestations of HIV/AIDS in patients who otherwise may be unaware to being infected with HIV. Communication with the patient is essential for early detection. This will help in dental hygiene care, because we as hygienists, are responsible for being able to identify abnormalities and lesions in the oral cavity. It is important to be able to notice slight variations from normal because early detection is critical, especially in autoimmune diseases that can progress very rapidly.
Personal Reflection: I chose to find an article on HIV/AIDS, primarily because of the lecture received in class, but also because of a patient that I knew from working at my previous dental office that was a victim of AIDS. Being around this patient was my first time being around an individual (that I knew of) that had AIDS. I remember thinking to myself that I was grateful that this patient was honest about marking this on his medical history. At first, when I saw that HIV/AIDS was checked "yes", I too was a little nervous to be assisting in providing dental treatment to him. As we discussed in class, there is a stigma that is unfortunately associated with individuals that are affected by this disease which causes them to shy away from being able to openly discuss their illness. It is disturbing to me that individuals that have a disease can be treated in a very unethical way. I have since realized that my nervousness at the time was due to a lack of knowledge about the disease. I am thankful for the education that I have received and hope to educate others and stop some of the stigma's that are so quickly placed on individuals suffering from disease. I enjoyed this journal article because of its incorporation of HIV/AIDS treatment and prevention not only in the United States, but also in other undeveloped areas. I now know first hand that education plays a huge role in how individuals with HIV/AIDS are treated. I really liked that there was an emphasis on the detection of lesions in the oral cavity because as I become a dental hygienist, it is my responsibility to be aware of oral lesions that can affect the life of an individual. Early detection leads to early treatment which is crucial in immunocompromised individuals.
Citation:
Patton, L., Ranganathan, K., Naidoo, S., Bhayat, A., Balasundaram, S., Adeyemi, O., & ... Chandra, L. (2011). Oral
lesions, HIV phenotypes, and management of HIV-related disease: Workshop 4A. Advances In Dental Research, 23(1),
112-116.
Additional Information:
http://www.actagainstaids.org/index.html Act Against AIDS is a national campaign that was launched by the Centers for Disease Control and Prevention (CDC) and the White House in 2009 that focuses on raising awareness among all Americans and reducing the risk of infection among individuals that are at high risk.
http://www.aids.org/ This is a very informational website that has a lot of current HIV/AIDS news articles that are very interesting.
**Images retrieved from google.com/images**