Lesiones orales y estado inmunológico de pacientes VIH+ expuestos o no al consumo de alcohol. Blanca Lucía Acosta de Velásquez Elisa María Pinzón Gómez Héctor Fabio Mueses Marín Jaime Galindo Quintero Toye Brewer John Lewis Gail Shor-Posner Santiago de Cali, 13 de Marzo 2008 Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano

Objetivos To characterize the profile of HIV+ alcohol users and non-users in relationship to oral health and disease status. Hypothesis 1: The incidence of oral lesions will be positively correlated with alcohol use and viral load level, and negatively correlated with CD4 cell count, controlling for HARRT. Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano

Tamaño del problema 2004 WHO = 25.7% of children aged 10 – 14 years old* 63.5% of adolescents between 15 and 18 years old consume alcohol.* General population the proportion of adults = 61% (it is more highest in males)* Alcohol consumption is an established risk factor for oral disease in general and is associated with oral lesions in HIV infected individuals, probably by increasing oral mucosal vulnerability to infection** Alcohol dependence was measured using criteria from the International Statistics Classification of Diseases and Related Health Problems (10th Revision) (WHO, 2004). (Chen el al., 2004). Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano

Tamaño del problema Our preliminary studies indicate a high proportion of HIV+ receiving care at an HIV Health Care Institutions in Cali, Colombia, exhibit oral lesions, and approximately 33,8% (108) Pinzón et al. and 30% (45) Acosta et al. report using alcohol. Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano

Tamaño del problema HIV+ Group - Prevalence of oral lesions Pinzón et al. (n = 319) Acosta et al. (n = 150) Alcohol Non- alcohol Alcohol Non- alcohol General prevalence of oral lesions 77% (246)90,7% (136) Fungal oral lesions 37,4% (34) 35,1% (80) 17,4% (8) 20,4% (21) Bacterial oral lesions 28,6% (26) 36,4% (83) 47,8% (22) 37,9% (39) Viral oral lesions 17,6% (16) 16,2% (37) 6,5% (3) 10,7% (11) Xerostomy 35,2% (32) 43,4% (99) ND Others ND 26,1% (12) 19,4% (20)

Consecuencias de no intervención Oral mucosal condition may be caused by local disease systemic disease, reaction to drugs or many other issues related to life-style factors such as consumption of tobacco and substance users* Alcohol is also metabolized in the oral mucosa by alcohol dehydrogenase. The activity of aldehide dehydrogenase is lacking in the oral mucosa, which could lead to the accumulation of acetaldehyde in oral tissues.** Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano (*Harris el al, 2004). (**Dong et al., 1996).

Consecuencias de no intervención Alcohol consumption is an established risk factor for oral disease in general and is associated with oral lesions in HIV infected individuals, probably by increasing oral mucosal vulnerability to infection*** Excess consumption of any type of alcohol has been thought to increase the risk of oral lesions especially oral cancer Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano (***Chen el al., 2004).

Resultados esperados Results of this study will establish baseline characteristics providing the basis for the development of future studies to determine the potential impact of alcohol use on oral health and strategies for optimal treatment and care in HIV infected individuals Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano

Métodos y diseño Observacional, analítico, cohorte fija. AUDIT (puntaje 8) servirá para asignar al grupo de expuestos (≥8) y no expuestos (<8). Seguimiento por un año Aparición de evento (lesión oral) Presencia, severidad y recurrencia Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano

Corporación de Lucha contra el SIDA Colegio Odontológico Colombiano