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Pediatr Infect Dis J. 2018 Aug 9. doi: 10.1097/INF.0000000000002166. [Epub ahead of print]

Gingival Recession and Localized Aggressive Periodontitis Among HIV-Infected Children and Adolescents Receiving Antiretroviral Therapy.

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Department of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Department of Immunology, School of Medicine, Faculty of Health Sciences, University of Pretoria.
Research Support Office, Faculty of Health Sciences, University of Pretoria.
Department of Paediatrics, School of Medicine, Faculty of Health Sciences, University of Pretoria.



Limited information is available on gingival recession or localised aggressive periodontitis among HIV-infected children and adolescents. This study reports on the prevalence of these conditions among children and adolescents receiving antiretroviral therapy (ART).


A cross-sectional study on HIV-infected children and adolescents attending a Paediatric HIV clinic in Gauteng, South Africa, between January 2013 and June 2016. Patients received an oral examination and oral hygiene instructions, irrespective of oral- or dental-related complaints. Hard and soft tissue pathology was managed and recorded, together with relevant demographic and clinical data. Statistical analysis was performed in Stata 14 with p <0.05 as significant.


A total of 554 children and adolescents aged 5 to 19 years (median age 12.2 years, IQR 10.3; 14.9) were included, of whom 78 (14.1%) presented with gingival recession on permanent mandibular incisors and/or localised aggressive periodontitis of molar teeth. Multivariable logistic regression revealed that patients with gingival recession and aggressive periodontitis had a significantly shorter duration of ART, and were more likely to have suboptimal HIV-control (CD4 count ≤500 cells/µL and/or HIV viral load ≥50 copies/mL) and be on advanced ART regimens after virological failure on 1- and 2-line treatment.


The results emphasise the importance of oral health care among HIV-infected children and adolescents from the onset, in order to prevent and manage conditions that could result in tooth loss and permanent disfigurement. This is of particular importance in the presence of virological failure and immunosuppression.

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