Despite progress in the Western world, HIV continues to ravage Kenya, where the infection rate is about 6%. About 140,000 to 180,000 of those infected are children who suffer from painful side effects that require significant oral care.
The Children’s Health Oral Management Project (CHOMP), however, aims to combat the disease and its oral manifestations. The collaboration brings together the University of Washington’s Department of Global Health and School of Dentistry, the University of Nairobi, and Kenya’s Ministry of Health and National AIDS/STI Control Programme.
In addition to launching new prevention initiatives, CHOMP is training practitioners including pediatric dentists, community oral health officers, and nurses to screen and treat oral manifestations related to HIV in children.
Also, CHOMP aims to strengthen the research partnership between its members and integrate oral exams into HIV treatment visits as it trains dental staff to diagnose and treat oral HIV-related diseases.
“I’m very excited,” said Dr. Ana Lucia Seminario of the University of Washington department of pediatric dentistry. “This is the first time they’ve included oral health in these discussions [of Kenya’s HIV challenges].”
Many of these children suffer from oral candidiasis, which includes a burning sensation in the mouth, nutrition problems, and changes in taste. Herpes simplex, linear gingival erythema, and painful recurring ulcers are possible as well.
“The disease is [also] associated with episodes of illness, fevers, diarrhea, and super-infections,” said Professor Arthur Musakulu Kemoli, chair of the department of pediatric dentistry and orthodontics at the University of Nairobi. “These factors can result in oral effects involving both hard and soft tissues.”
HIV’s devastation doesn’t stop in the oral cavity, though, as it impacts the general health and quality of life of its victims as well as their families and communities, Kemoli said. While 15% of the deaths of children younger than the age of 5 years can be attributed to HIV, treatment has improved. But oral care is still necessary.
“Children aren’t dying from AIDS as they did in the early years when the disease appeared, so now it’s time to look at other aspects of the disease,” said Seminario, who visited Kenya in January to review recent HIV research, train oral health professionals, and refine CHOMP’s 2016 plans.
Highly active anti-retroviral therapy has helped reduce the rate of HIV-related oral symptoms since its introduction in the 1990s, but many patients still see oral lesions persist after treatment, and the drugs themselves can produce undesirable side effects, Seminario said.
“As dentists, we see oral defects that make us more aware of the consequences of medications,” Seminario said, noting that the anti-retrovirals can affect infant oral health.
Antibiotics also can have an effect on the development of dental tissue. HIV-infected children have suffered developmental effects in tooth enamel and soft tissue linked to medications or the disease itself, Kemoli explained.
CHOMP’s leaders believe that just a few practitioners can make a significant difference. As few as 10 can screen and treat as many as 4,000 children a year, Kemoli said. Patients can be screened in a hospital, clinic, school, or even at home.
To facilitate screenings, CHOMP wants to develop a salivary HIV test for children in lieu of drawing blood. Also, additional resources could help the organization expand beyond Kenya, as HIV rates in children are similar or even worse across the region.
These approaches don’t need to be limited to Africa either, as Seminario sees potential for raising awareness of pediatric HIV infections in the United States and focusing conversations between healthcare providers and pregnant women.
“I have HIV-positive patients, and the parents are very grateful when you discuss these issues with them,” Seminario said.