HIV Infection & Oral Health
Smiles Across America Webinar Series
05/25/2016
Connect with OHA! /Oral Health America
@Smile4Health
/Oral Health America
@Smile4Health
HOUSEKEEPING INFORMATION • •
Please remember to MUTE your phone. Questions are welcome! We’ll allow 10-15 minutes after the presentation for questions. •
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• •
Questions will be accepted in writing through the control panel on the upper right hand of your screen. Submit questions at any time; we will address them at the end of the presentation.
Webinar is being recorded; for rebroadcast on OHA’s website – OralHealthAmerica.org Your feedback is important to us. Please take our brief webinar evaluation after this session; link will be sent via email.
CE Credit Available
OUR MISSION Oral Health America’s mission is to change lives by connecting communities with resources to drive access to care, increase health literacy, and advocate for policies that improve overall health through better oral health for all Americans, especially those most vulnerable.
OHA PRIORITIES OHA’s Programs and Campaigns are designed to improve access to care, oral health literacy and policies that prioritize the impact of oral health on the overall health of all Americans – particularly those most vulnerable.
ACCESS
HEALTH LITERACY
ADVOCACY
Campaigns for Oral Health Equity Educate the public, including policy makers, about the importance of oral health for overall health Emphasize the need to prioritize oral disease alongside other serious health conditions Advocate for policies that positively impact programs and stakeholders Current campaigns include:
toothwisdom.org
Advocacy
Health Education & Communications
Professional Symposia
Demonstration Projects
Grant Funding
Product Donation
Technical Assistance
HIV INFECTION & ORAL HEALTH Mona Van Kanegan, DDS, MS, MPH Oral Health Forum Heartland Health Outreach 5.25.2016
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Session Learning Objectives 1. Participants will explore current HIV epidemiology in Chicago, Illinois and in the United States. 2. Participants will increase their general knowledge of how HIV infection is medically managed. 3. Participants will review prevalence, sequelae and profound disparities that exist in oral health and access to care. 4. Highlight opportunities for oral health promotion.
Why Oral Health Matters? • In HIV infection, oral disease
manifestation may be an early sign of new infection, signify disease progression or treatment failure and may serve as a trigger for medical care • Team/collaborative care approach affects the course of HIV epidemic (HIV screening), enables early testing/care and optimized overall health outcomes for HIV infected persons
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Significance of Oral Lesions Support Overall • Often the first clinical signs of • TreatWell-being dental disease, eliminate of Patients HIV disease pain, restore function • Support patient compliance with
medical care • Reinforce adherence to • • • •
medications Screen for medication side effects / toxicities Tobacco cessation; referral for drug / alcohol abuse STD prevention / risk reduction Dental pain interferes with eating and proper nutrition
• Help identify undiagnosed
patients (diabetes, HTN, HIV) and refer them for testing and medical care
• • • •
Signify disease progression Marker for ART failure Impact medication compliance Impact proper nutrition
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Session Learning Objective 1. Participants will explore current HIV epidemiology in Chicago, Illinois and in the United States.
Rates of Adults and Adolescents Living with Diagnosed HIV Infection, Year-end 2012—United States and 6 Dependent Areas N = 931,449
Total Rate = 352.3
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.
Diagnoses of HIV Infection and Population by Race/Ethnicity, 2013—United States
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race.
Diagnoses of HIV Infection among Adults and Adolescents, by Sex and Race/Ethnicity, 2013—United States and 6 Dependent Areas
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race.
Diagnoses of HIV Infection among Adults and Adolescents, by Transmission Category, 2013—United States and 6 Dependent Areas N = 47,958
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.
Illinois: Current HIV Data Source: AIDSVu of the Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc. Can find county level data at County Health Rankings- search HIV prevalence and get your county HIV rate per 100,000 (2009 data) Brown County – 590 Cook – 588 Livingston - 699
http://www.countyhealthrankings.org/app/illinois/2013/measure/outcomes/61/data
Chicago: Current Trends in HIV Data Courtesy of the Chicago Department of Public Health, 2015
Trends in HIV Infection Diagnoses by Sex, Chicago, 2000-2013 (as of 9/30/14) 1,600
Number of Diagnoses
1,400 1,200 927
1,000 800 600 400
163
200 0 2000
2001
2002
2003
2004
2005
2006 2007 2008 Year of Diagnosis
Female
2009
2010
2011
2012
2013
Male
26,000 living confirmed HIV cases in Chicago; 1100 new cases ID each year
Trends in HIV Infection Diagnoses by Race/Ethnicity, Chicago, 2000-2013 (as of 9/30/14) 1,200
Number of Diagnoses
1,000 800 572
600 400
239 200
215 52
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year of Diagnosis Black
White
Hispanic
Other
2011
2012
2013
Trends in HIV Infection Diagnoses by Age, Chicago, 2000-2013 (as of 9/30/14) 800 700
Number of Diagnoses
600 500 421
400 300
259 200
189 128
100 0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year of Diagnosis
13-19
20-29
30-39
40-49
50-59
60+
54 32 2013
Trends in HIV Infection Diagnoses by Mode of Transmission, Chicago, 2000-2013 (as of 9/30/14) 1,000 900 818
Number of Diagnoses
800 700 600 500 400 300 200
176
100
34 28
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year of Diagnosis
MSM
IDU
MSM/IDU
Het
2011
2012
2013
http://aidsvu.maplarge.com/av2014/aidsvumap.html?city=chi cago&password=chica7375
http://aidsvu.org/map/?city=Chicago
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Session Learning Objectives 2. Participants will increase their general knowledge of how HIV infection is medically managed.
Vision of the National HIV/AIDS Strategy “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance will have unfettered access to high-quality, life-extending care, free from stigma and discrimination�
Blueprint for HIV Treatment Success
Ulett et al. AIDS Pt Care STDS 2009;23:41-49, Mugavero et al. Clin Infect Dis 2011;52(S2).
Link to Care = Avoiding delayed presentation
Late Diagnosis
Late Presentation
Delayed Presentation
National HIV/AIDS Strategy: Increase proportion of newly diagnosed patients linked to clinical care w/in 3 months of HIV diagnosis 65% to 85% by 2015
National HIV/AIDS Strategy Increase HIV sero-status awareness from 79% to 90%
Increase linkage to care w/in 3 months of Dx from 65% to 85%
Increase RW clients in continuous care from 73% to 80%
Increase proportion of HIV Dx’d persons with undetectable VL by 20%
21% Undiagnosed 31% Not linked 41% Not retained
Adapted from: Gardner et al. Clin Infect Dis 2011;52:793, Cohen et al. MMWR 2011;60:1618
HIV Antiretroviral Therapy
Lifecycle of HIV
“self-propelled automaton molecular machine synthesizing billions of viral particles that infect and destroy cells critical to immune function�
First – check for resistance Genotype • indirect assay detects
mutations in the genes coding for RT & PR • lower cost, more rapid turnaround time • may predict resistance before clinically apparent • expert consultation recommended for patients with complex mutation patterns
HIV Antiretroviral Therapy
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Session Learning Objectives 3. Participants will review prevalence, sequelae and profound disparities that exist in oral health and access to care.
Why do Oral Complications Occur? • Changes in immune system • Medications used to treat HIV • Same as everyone else – host genetic factors,
poor oral hygiene, smoking, aging
HIV Oral Health Review, Evaluation Center for HIV and Oral Health
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Compounded by Competing Medical Issues • HIV patients often have multiple medical issues, and •
• • •
dental care may not be given the priority it deserves. Patients may be overwhelmed with care needs and deemphasize oral care without realizing its importance to overall health. Financial limitations may force patients and families to choose to forgo oral health care. Poor food choices increase risk of dental diseases After meeting the need for primary care, dental care is the most common unmet health need for PLWHIV/AIDS.
“Bacteria are the culprits behind the two most
common oral health conditions affecting everyone, regardless of HIV status: dental caries and
periodontal disease. These bacterial infections that begin in the mouth can potentially inflict
great harm to the heart, brain, and other organs if not treated, particularly in PLWHA
with severely compromised immune systems.� HRSA CAREAction June 2008. 46
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Systemic Bacterial Extension
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Session Learning Objectives
4. Highlight opportunities for oral health promotion.
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Patient Level Health Promotion Screen for Disease and Risk • History, Risk Assessment, and Examination • Provide anticipatory guidance, empower patients to act to
improve their own health circumstances • Oral Health Prevention for caries, periodontal disease, smoking cessation • Early Referral, risked based recall schedule • Fluoride Promotion, Silver Diamine Fluoride (SDF)
Oral Manifestations of HIV Disease • Oral manifestations of HIV infection are a frequent
component of disease progression • But there has been a significant decrease in the overall prevalence of oral lesions from 47 – 85% pre-ART to 3246% post ART • Factors, which predispose expression of oral lesions, include • CD4 counts less than 200 cells/mm3 • Viral load greater than 3,000 copies/mL • xerostomia (dry mouth) • poor oral hygiene • smoking HIV Oral Health Review, Evaluation Center for HIV and Oral Health
Patton et al. 2000; Schmidt-Westhausen et al. 2000; Gaitan Cepeda53 et al. 2008, Tamí-Maury IM et al. 2011
Common Oral Health Problems in HIV Aphthous stomatitis
Caries
Herpes simplex
Human papilloma virus
Linear gingival erythema
Necrotizing ulcerative periodontitis
Oral candidiasis
Oral hairy leukoplakia
Periodontal disease
Head and neck cancer
HRSA CAREAction June 2008.
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• Smiles for Life a National
Resources & Thank You!
Oral Health Curriculum: smilesforlifeoralhealth.org • http://hivdent.org/ • & slides from Gail Patrick,
MD, MPP, AAHIVS
Question and Answer Session • Questions are welcome! This session may last for 10-15 minutes. • Write your questions in your control panel on the upper right hand of your screen. • Submit questions at any time.
CE Credit Available
Contact Information Dr. Mona Van Kanegan MVanKanegan@heartlandalliance.org
Tina Montgomery Tina.Montgomery@oralhealthamerica.org