Non-Cochrane · intervention · PM36231240
Impact of Antiretroviral Therapy on Oral Health among Children Living with HIV: A Systematic Review and Meta-Analysis.
Lam Phoebe Pui Ying, Zhou Ni, Yiu Cynthia Kar Yung, et al. · International journal of environmental research and public health · 2022 · PubMed · doi:10.3390/ijerph191911943
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
33
current version
GRADE rated
28
No studies
3
Included studies
14
linked below
No studies 3 · 9.1%Ungraded 2 · 6.1%Very low 28 · 84.8%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents (<18 years) living with HIV (CLWH) | CLWH aged 3 months to 17 years (n=3525) |
| Intervention | Antiretroviral therapy (ART); combined ART (cART) for medication-type comparisons | ART / cART / post-cART / various regimens (n=793 on different ART; 2438 in within-person cohorts) |
| Comparison | Treatment-naive CLWH; for medication-type comparisons, conventional monotherapy or dual therapy | No medication (treatment-naive, n=294); pre-cART; monotherapy or dual therapy |
| Outcomes | (a) Dental caries; (b) oral hygiene and periodontal health; (c) HIV-related orofacial diseases (WHO clinical staging); (d) salivary immunoglobulin quantity; (e) oral microbiome count; (f) dental development and maturation | Caries; periodontal disease; oral hygiene; oral candidiasis; other HIV-related orofacial diseases; salivary IgA; dental development |
| Study designs | Case-control observational studies and randomised controlled studies with English full text; cross-sectional and uncontrolled interventional studies excluded | 14 observational studies (3 cohort/within-person, 11 parallel-group case-control); no RCTs |
| Timing | Not specified | Not specified (ART duration examined as a modifier; >=3 years associated with lower candidiasis) |
Search date: 2022-08-03 (inception to 3 August 2022). Databases: Ovid Embase; Ovid MEDLINE; PubMed; Scopus (plus reference-list hand-search)
Questions and results
Antiretroviral therapy (any, including cART) vs No antiretroviral medication (treatment-naive)
Population: Children and adolescents (<18 years) living with HIV (CLWH)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Salivary immunoglobulin A (SIgA) concentration Evidence on salivary IgA in CLWH on versus off ART was divergent and inconclusive (very low certainty). Source: Results 3.7 (Saliva Immunoglobulins Quantity) · same question in other reviews | Two studies gave divergent results: Subramaniam (2015) reported higher SIgA in children on ART for more than 3 years than pre-ART (8.6 (SD 2.9) vs 6.2 (SD 1.7) mg/dL; p < 0.001), whereas Pomarico (2009) found lower… | 2 studies | Very low Downgraded: imprecision, inconsistency |
Acute necrotising ulcerative gingivitis prevalence Acute necrotising ulcerative gingivitis was significantly more prevalent in treatment-naive CLWH than in those on ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 0.00 [0.00, 0.02] | NR | Very low Downgraded: imprecision, inconsistency |
Parotid hypertrophy prevalence Parotid hypertrophy was significantly more prevalent in treatment-naive CLWH than in those on ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 0.01 [0.00, 0.05] | NR | Very low Downgraded: imprecision, inconsistency |
Angular cheilitis prevalence No significant difference in angular cheilitis between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 0.58 [0.17, 1.99] | NR | Very low Downgraded: imprecision, inconsistency |
Ulcerative stomatitis prevalence Ulcerative stomatitis was significantly more prevalent in treatment-naive CLWH than in those on ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 0.03 [0.02, 0.07] | NR | Very low Downgraded: imprecision, inconsistency |
Linear gingival erythema prevalence No significant difference in linear gingival erythema between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 1.29 [0.58, 2.88] | NR | Very low Downgraded: imprecision, inconsistency |
Oral candidiasis prevalence Population: Children and adolescents living with HIV ART was associated with lower oral candidiasis prevalence. Source: Results 3.5 · same question in other reviews | OR 0.35 [0.19, 0.63] | 7 studies | Very low Downgraded: imprecision, inconsistency |
Dental development and maturation A single small study suggested delayed dental development in CLWH on ART, but the evidence was insufficient to draw conclusions (very low certainty). Source: Results 3.8 (Dental Development and Maturation) · same question in other reviews | One study (Trigueiro 2010) reported that dental age exceeded chronological age by 5.35 to 14.36 months (SE 3.03 to 15.86) in children on NRTI/PI/NNRTI regimens versus -0.67 months in those without medication; the… | 1 study | Very low Downgraded: imprecision |
Oral hygiene status Oral hygiene status did not differ significantly between CLWH with and without ART (very low certainty). Source: Results 3.4 (Oral Hygiene and Periodontal Status); Figure 3; Supplementary Table S1 · same question in other reviews | OR 0.73 [0.13, 4.26] | 0 studies | Ungraded Downgraded: imprecision, inconsistency |
Mucocele prevalence No significant difference in mucocele between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 0.02 [0.00, 1.09] | NR | Very low Downgraded: imprecision, inconsistency |
Kaposi's sarcoma prevalence Kaposi's sarcoma was significantly more prevalent in treatment-naive CLWH than in those on ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 0.00 [0.00, 0.03] | NR | Very low Downgraded: imprecision, inconsistency |
Recurrent oral ulceration prevalence No significant difference in recurrent oral ulceration between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 1.50 [0.72, 3.13] | NR | Very low Downgraded: imprecision, inconsistency |
Oral hairy leukoplakia prevalence No significant difference in oral hairy leukoplakia between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 2.75 [0.39, 19.43] | NR | Very low Downgraded: imprecision, inconsistency |
Periodontal disease prevalence ART was not associated with a significant difference in periodontal disease prevalence among CLWH (very low certainty). Source: Results 3.4 (Oral Hygiene and Periodontal Status); Figure 3; Supplementary Table S1 · same question in other reviews | OR 0.82 [0.46, 1.44] | 2 studies · 250 participants | Very low Downgraded: imprecision |
Mucosal hyperpigmentation prevalence No significant difference in mucosal hyperpigmentation between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 1.79 [0.89, 3.61] | NR | Very low Downgraded: imprecision, inconsistency |
Chronic herpes simplex infection prevalence No significant difference in chronic herpes simplex infection between CLWH with and without ART (very low certainty). Source: Results 3.6 (Other HIV-Related Orofacial Diseases); Supplementary Table S1 and Supplementary Figure S1 · same question in other reviews | OR 2.47 [0.88, 6.97] | NR | Very low Downgraded: imprecision, inconsistency |
Dental caries experience ART was not associated with a significant difference in dental caries experience among CLWH (very low certainty). Source: Results 3.4 (CLWH under ART versus those without Dental Caries Experience); Supplementary Table S1 · same question in other reviews | OR 0.91 [0.5, 1.65] | 2 studies · 301 participants | Very low Downgraded: imprecision, inconsistency |
Combined antiretroviral therapy (cART) vs No antiretroviral medication (treatment-naive)
Population: Children and adolescents (<18 years) living with HIV (CLWH)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral candidiasis prevalence cART cART was associated with a significantly lower prevalence of oral candidiasis in CLWH (very low certainty). Source: Results 3.5 (Oral Candidiasis and Oral Microbiome Count); Figure 4; Supplementary Table S1 · same question in other reviews | OR 0.35 [0.24, 0.51] | NR | Very low Downgraded: imprecision, inconsistency |
Combined antiretroviral therapy (post-cART) vs Pre-cART (same children, before therapy)
Population: Children and adolescents (<18 years) living with HIV (CLWH)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral candidiasis prevalence After vs before cART (within-person) · post-cART vs pre-cART Oral candidiasis prevalence fell significantly after cART compared with before cART in the same children (very low certainty). Source: Results 3.5 (Oral Candidiasis and Oral Microbiome Count); Figure 4; Supplementary Table S1 · same question in other reviews | OR 0.19 [0.15, 0.25] | NR | Very low Downgraded: imprecision, inconsistency |
Monotherapy or dual antiretroviral therapy vs No antiretroviral medication (treatment-naive)
Population: Children and adolescents (<18 years) living with HIV (CLWH)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral candidiasis prevalence monotherapy or dual therapy Oral candidiasis prevalence did not differ significantly between treatment-naive CLWH and those on monotherapy or dual therapy (very low certainty). Source: Results 3.5 (Oral Candidiasis and Oral Microbiome Count) · same question in other reviews | No significant difference in oral candidiasis prevalence was found between treatment-naive CLWH and those under monotherapy or dual therapy (no numeric estimate reported in the text). | NR | Very low Downgraded: imprecision, inconsistency |
Combined antiretroviral therapy (cART) vs Monotherapy or dual antiretroviral therapy
Population: Children and adolescents (<18 years) living with HIV (CLWH)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrent oral ulceration prevalence No significant difference in recurrent oral ulceration between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in recurrent oral ulceration between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 1 study(ies). | 1 study | Very low Downgraded: imprecision |
Kaposi's sarcoma prevalence No significant difference in kaposi's sarcoma between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in kaposi's sarcoma between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 1 study(ies). | 1 study | Very low Downgraded: imprecision |
Angular cheilitis prevalence No eligible studies compared angular cheilitis between different ART regimens. Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No eligible studies compared angular cheilitis between CLWH on different ART medications. | 0 studies | No studies |
Dental caries prevalence and severity No significant difference in dental caries/severity between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in dental caries/severity between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 2 study(ies). | 2 studies | Very low Downgraded: imprecision, inconsistency |
Dental development and maturation No eligible studies compared dental development and maturation between different ART regimens. Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No eligible studies compared dental development and maturation between CLWH on different ART medications. | 0 studies | No studies |
Chronic herpes simplex infection prevalence No significant difference in chronic herpes simplex infection between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in chronic herpes simplex infection between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 1 study(ies). | 1 study | Very low Downgraded: imprecision |
Linear gingival erythema prevalence No significant difference in linear gingival erythema between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in linear gingival erythema between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 1 study(ies). | 1 study | Very low Downgraded: imprecision |
Acute necrotising ulcerative periodontitis prevalence No significant difference in acute necrotising ulcerative periodontitis between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in acute necrotising ulcerative periodontitis between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 1 study(ies). | 1 study | Very low Downgraded: imprecision |
Oral hairy leukoplakia prevalence No eligible studies compared oral hairy leukoplakia between different ART regimens. Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No eligible studies compared oral hairy leukoplakia between CLWH on different ART medications. | 0 studies | No studies |
Gingivitis prevalence No significant difference in gingivitis between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in gingivitis between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 2 study(ies). | 2 studies | Very low Downgraded: imprecision, inconsistency |
Oral candidiasis prevalence cART was associated with a significantly lower prevalence of oral candidiasis than monotherapy or dual therapy (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Figure 5; Supplementary Table S2 · same question in other reviews | OR 0.22 [0.16, 0.29] | 4 studies | Very low Downgraded: imprecision, inconsistency |
Persistent parotid enlargement prevalence No significant difference in persistent parotid enlargement between ART regimens (very low certainty). Source: Results 3.9 (CLWH under Different ART Medications); Supplementary Table S2 · same question in other reviews | No significant difference in persistent parotid enlargement between CLWH on cART and those on monotherapy or dual therapy (no numeric estimate reported in the text); 1 study(ies). | 1 study | Very low Downgraded: imprecision |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral Candida carriage and salivary yeast concentration | no estimate extracted | 1 study | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Yes | NRSI: Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: Yes | NRSI: Partial Yes · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | N/A | no |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Low | no |
Included primary studies 14
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Birungi 2020 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Baghirath 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Divakar 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Flanagan 2000 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Jose 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Konstantyner 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Melo 2009 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Mensana 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Oliscovicz 2016 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Pomarico 2009 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ponnam 2012 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Prasitsuebsai 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Subramaniam 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Trigueiro 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Prevalence of Dental Caries and Associated Factors in East Africa, 2000-2020: Systematic Review and Meta-Analysis. (2021) | 1 | 0.01 |