Non-Cochrane · aetiology · PM36232165
Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis.
Lam Phoebe Pui Ying, Zhou Ni, Wong Hai Ming, et al. · International journal of environmental research and public health · 2022 · PubMed · doi:10.3390/ijerph191912864
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
25
current version
GRADE rated
0
No studies
3
Included studies
21
linked below
No studies 3 · 12%Ungraded 22 · 88%Very low 0 · 0%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 below 18 years | Children and adolescents (<18 years); 1002 HIV-infected subjects and 975 healthy controls across 12 studies (n=1977) |
| Intervention | Undergoing antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART) for HIV | ART/HAART (12 studies) |
| Comparison | Healthy HIV-negative controls | Healthy HIV-negative controls (siblings or school/clinic controls) |
| Outcomes | Dental caries (prevalence and severity); oral hygiene and periodontal health; HIV-related orofacial diseases by WHO clinical staging (stage 2: angular cheilitis, herpes zoster, linear gingival erythema, recurrent oral ulcerations, parotid enlargement; stage 3: oral candidiasis, oral hairy leukoplakia, acute necrotizing ulcerative gingivitis/periodontitis; stage 4: herpes simplex infection, Kaposi sarcoma); salivary immunoglobulins; oral candidiasis; dental development | Caries prevalence (2 studies); caries severity (1); oral hygiene (1); periodontal disease (2); angular cheilitis (2); linear gingival erythema (2); recurrent oral ulceration (3); parotid enlargement (1); oral candidiasis (5); oral hairy leukoplakia (2); hyperpigmentation (3); mucocele (1); ulcerative stomatitis (1); salivary IgA (1); dental development (3); ANUG, herpes simplex, Kaposi sarcoma (no studies) |
| Study designs | Case-control observational studies with full-text reports in English | 12 case-control studies (10 low risk of bias, 2 severe risk of bias by ROBINS-I) |
| Timing | Not specified | Cross-sectional (case-control) |
Search date: Inception to 29 July 2022. Databases: Ovid Embase, Ovid MEDLINE, PubMed, Scopus (plus reference-list hand searching)
Questions and results
Living with HIV and undergoing antiretroviral therapy (ART/HAART) vs Healthy HIV-negative controls
Population: Children and adolescents (<18 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mucosal (oral) hyperpigmentation Cross-sectional (case-control; single time point) CLWH on ART had significantly higher prevalence of mucosal hyperpigmentation than healthy controls (pooled OR 20.35, 95% CI 3.86 to 107.39); the authors described the certainty as low. Source: Table 2 (Other oral health-related diseases); Results 3.6; Discussion; Figure 5d · same question in other reviews | OR 20.35 [3.86, 107.39] | 3 studies · 407 participants | Ungraded |
Dental development / dental age (mineralization chronology) Cross-sectional (case-control; single time point) No significant overall difference in dental development between CLWH on ART and healthy controls (three studies, narrative synthesis). Source: Results 3.9; Discussion · same question in other reviews | Three studies (Fernandes 2007, de Souza 2015, Holderbaum 2005) assessed dental age (Nolla/Willems methods); Fernandes and de Souza found no significant difference between groups; Holderbaum reported mixed sex-specific… | 3 studies | Ungraded |
Recurrent oral ulcerations (WHO clinical stage 2) Cross-sectional (case-control; single time point) CLWH on ART had significantly higher prevalence of recurrent oral ulcerations than healthy controls (pooled OR 6.83, 95% CI 1.18 to 39.53). Source: Table 2 (WHO clinical staging 2); Results 3.6; Figure 5a · same question in other reviews | OR 6.83 [1.18, 39.53] | 3 studies · 284 participants | Ungraded |
Kaposi's sarcoma (WHO clinical stage 4) Cross-sectional (case-control; single time point) No eligible studies reported Kaposi's sarcoma. Source: Table 2 (WHO clinical staging 4) · same question in other reviews | Planned WHO stage 4 outcome; no eligible studies (Table 2 lists 'None'). | 0 studies | No studies |
Acute necrotizing ulcerative gingivitis/periodontitis (WHO clinical stage 3) Cross-sectional (case-control; single time point) No eligible studies reported acute necrotizing ulcerative gingivitis/periodontitis. Source: Table 2 (WHO clinical staging 3) · same question in other reviews | Planned WHO stage 3 outcome; no eligible studies (Table 2 lists 'None'). | 0 studies | No studies |
Chronic herpes simplex infection (WHO clinical stage 4) Cross-sectional (case-control; single time point) No eligible studies reported chronic herpes simplex infection. Source: Table 2 (WHO clinical staging 4) · same question in other reviews | Planned WHO stage 4 outcome; no eligible studies (Table 2 lists 'None'). | 0 studies | No studies |
Dental caries prevalence (DMFT/dmft/DMFS/dmfs > 0) Cross-sectional (case-control; single time point) · Primary dentition (dmft > 0) In primary dentition, CLWH on ART had higher caries prevalence than healthy controls (OR 1.93, 95% CI 1.34 to 2.79; single study). Source: Table 2 (Dental caries prevalence and severity); Results 3.4 · same question in other reviews | OR 1.93 [1.34, 2.79] | 1 study · 564 participants | Ungraded |
Oral hairy leukoplakia (WHO clinical stage 3) Cross-sectional (case-control; single time point) No difference in oral hairy leukoplakia between groups (pooled OR 1.00, 95% CI 0.06 to 16.19); lesion essentially absent in both. Source: Table 2 (WHO clinical staging 3); Results 3.6; Figure 6b · same question in other reviews | OR 1.00 [0.06, 16.19] | 2 studies · 217 participants | Ungraded |
Periodontal disease (gingivitis/periodontitis) Cross-sectional (case-control; single time point) CLWH on ART had significantly higher prevalence of periodontal disease than healthy controls (pooled OR 3.11, 95% CI 1.62 to 5.97; moderate heterogeneity). Source: Table 2 (Oral hygiene and periodontal status); Results 3.5; Figure 4 · same question in other reviews | OR 3.11 [1.62, 5.97] | 2 studies · 250 participants | Ungraded |
Dental caries prevalence (DMFT/dmft/DMFS/dmfs > 0) Cross-sectional (case-control; single time point) · Permanent dentition (DMFT > 0) In permanent dentition, CLWH on ART had higher caries prevalence than healthy controls (OR 2.49, 95% CI 1.86 to 3.32; single study). Source: Table 2 (Dental caries prevalence and severity); Results 3.4 · same question in other reviews | OR 2.49 [1.86, 3.32] | 1 study · 724 participants | Ungraded |
Salivary immunoglobulin A (SIgA) concentration Cross-sectional (case-control; single time point) No significant difference in total salivary IgA between CLWH and healthy controls, though anti-Candida SIgA was higher in HIV groups; narrative only. Source: Results 3.7 · same question in other reviews | Pomarico 2009 reported no significant difference in total SIgA among HIV-ART, HIV-HAART, and healthy children, but significantly higher anti-Candida albicans SIgA in the two HIV groups; no effect estimate pooled. | 1 study | Ungraded |
Dental caries prevalence (DMFT/dmft/DMFS/dmfs > 0) Cross-sectional (case-control; single time point) Pooled analysis showed higher dental caries prevalence among CLWH on ART (OR 2.70, 95% CI 2.01 to 3.62), but the two studies were divergent and the authors concluded HIV/ART is not a predisposing factor to caries. Source: Table 2 (Dental caries prevalence and severity); Results 3.4; Figure 3 · same question in other reviews | OR 2.70 [2.01, 3.62] | 2 studies · 1028 participants | Ungraded |
Mucocele Cross-sectional (case-control; single time point) No significant difference in mucocele between groups (OR 3.03, 95% CI 0.12 to 75.37; single study). Source: Table 2 (Other oral health-related diseases); Results 3.6 · same question in other reviews | OR 3.03 [0.12, 75.37] | 1 study · 190 participants | Ungraded |
Persistent parotid enlargement (WHO clinical stage 2) Cross-sectional (case-control; single time point) No significant difference in persistent parotid enlargement between groups (OR 10.36, 95% CI 0.53 to 201.45; single study, very imprecise). Source: Table 2 (WHO clinical staging 2); Results 3.6 · same question in other reviews | OR 10.36 [0.53, 201.45] | 1 study · 60 participants | Ungraded |
Ulcerative stomatitis Cross-sectional (case-control; single time point) One study found significantly higher ulcerative stomatitis among CLWH on ART (OR 28.59, 95% CI 1.67 to 490.32), though the estimate is very imprecise. Source: Table 2 (Other oral health-related diseases); Results 3.6; Conclusions · same question in other reviews | OR 28.59 [1.67, 490.32] | 1 study · 190 participants | Ungraded |
Poor oral hygiene (simplified oral hygiene index, OHI-S > 3) Cross-sectional (case-control; single time point) No significant difference in oral hygiene between CLWH on ART and healthy controls (OR 1.23, 95% CI 0.73 to 2.07; single study). Source: Table 2 (Oral hygiene and periodontal status); Results 3.5 · same question in other reviews | OR 1.23 [0.73, 2.07] | 1 study · 837 participants | Ungraded |
Angular cheilitis (WHO clinical stage 2) Cross-sectional (case-control; single time point) No significant difference in angular cheilitis prevalence between CLWH and healthy controls (pooled OR 1.95, 95% CI 0.16 to 23.65). Source: Table 2 (WHO clinical staging 2); Results 3.6; Figure 5b · same question in other reviews | OR 1.95 [0.16, 23.65] | 2 studies · 224 participants | Ungraded |
Oral candidiasis (WHO clinical stage 3) Cross-sectional (case-control; single time point) CLWH on ART had markedly higher prevalence of oral candidiasis than healthy controls (pooled OR 16.94, 95% CI 5.06 to 56.70). Source: Table 2 (WHO clinical staging 3); Results 3.6 and 3.8; Figure 5c · same question in other reviews | OR 16.94 [5.06, 56.70] | 5 studies | Ungraded |
Linear gingival erythema (WHO clinical stage 2) Cross-sectional (case-control; single time point) No difference in linear gingival erythema between groups (pooled OR 1.00, 95% CI 0.06 to 16.19); the lesion was essentially absent in both groups. Source: Table 2 (WHO clinical staging 2); Results 3.6; Figure 6a · same question in other reviews | OR 1.00 [0.06, 16.19] | 2 studies · 224 participants | Ungraded |
Dental caries severity (median DMFT/dmft/DMFS/dmfs) Cross-sectional (case-control; single time point) One study reported higher median caries severity among CLWH under 12 years; no meta-analytic estimate was pooled. Source: Results 3.4 · same question in other reviews | Rajonson 2017 reported significantly higher median DMFT/dmft/DMFS/dmfs among CLWH than uninfected children below 12 years; no pooled effect estimate reported. | 1 study | Ungraded |
CD4+ T-cell count <250 cells/mm3 vs CD4+ T-cell count >=250 cells/mm3
Population: Children and adolescents living with HIV on ART/HAART
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
HIV-related oral lesions Cross-sectional (case-control; single time point) · CD4+ T-cell count <250 cells/mm3 vs higher Lower CD4+ counts (<250 cells/mm3) were associated with roughly twice the odds of HIV-related oral lesions in two studies (not pooled). Source: Results 3.10; Table 2 · same question in other reviews | CLWH with CD4+ <250 cells/mm3 were about twice as likely to have HIV-related oral lesions: Baghirath 2013 OR 1.916 (95% CI 0.613 to 2.513), p=0.001; Divakar 2015 OR 1.999 (95% CI 0.129 to 3.688), p=0.001. Not pooled. | 2 studies | Ungraded |
ART/HAART duration <3 years vs ART/HAART duration >=3 years
Population: Children and adolescents living with HIV on ART/HAART
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Other orofacial opportunistic infections (linear gingival erythema, hairy leukoplakia, angular cheilitis, oral ulcers) Cross-sectional (case-control; single time point) · ART/HAART duration <3 years vs >=3 years ART/HAART duration had minimal influence on the prevalence of orofacial opportunistic infections other than candidiasis (no significant differences). Source: Results 3.10; Abstract · same question in other reviews | Except for candidiasis, no significant differences in the prevalence of opportunistic infection manifestations (linear gingival erythema, hairy leukoplakia, angular cheilitis, oral ulcers) between ART duration <3 years… | 2 studies | Ungraded |
Oral candidiasis Cross-sectional (case-control; single time point) · ART/HAART duration <3 years vs >=3 years Oral candidiasis prevalence differed by ART duration (OR 17.93, 95% CI 3.69 to 83.12). Source: Results 3.10; Table 2 · same question in other reviews | OR 17.93 [3.69, 83.12] | 2 studies | Ungraded |
CD4+ T-cell count below 250 cells/mm3
Population: Children living with HIV receiving ART
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
HIV-related oral lesions CD4+ T-cell count below 250 cells/mm3 One reported study did not show a clear difference in HIV-related oral lesions for children with CD4+ T-cell counts below 250 cells/mm3. Source: Results 3.10 (Baghirath 2013) · same question in other reviews | OR 1.916 [0.613, 2.513] | 1 study | Ungraded |
HIV-related oral lesions CD4+ T-cell count below 250 cells/mm3 One reported study did not show a clear difference in HIV-related oral lesions for children with CD4+ T-cell counts below 250 cells/mm3. Source: Results 3.10 (Divakar 2015) · same question in other reviews | OR 1.999 [0.129, 3.688] | 1 study | Ungraded |
Included primary studies 21
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Cerqueira et al., 2010 Oral Candida colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in Brazil: the… PMID:20040023 | 1 other review | not stated | not extracted yet | not extracted yet |
| Ponnam et al., 2012 Oral manifestations of human immunodeficiency virus in children: An institutional study at highly active antiretroviral therapy centre in… PMID:22923890 | 1 other review | not stated | not extracted yet | not extracted yet |
| Rajonson et al., 2017 High prevalence of dental caries among HIV-infected children in West Africa compared to uninfected siblings. PMID:28233316 | 1 other review | not stated | not extracted yet | not extracted yet |
| Baghirath 2013 Oral manifestations of HIV in children receiving anti-retroviral therapy in Hyderabad, India DOI:10.1007/s40368-013-0028-5 | this review only | not stated | not extracted yet | not extracted yet |
| Baghirath et al., 2013 Oral manifestations of HIV in children receiving anti-retroviral therapy in Hyderabad, India. PMID:23760809 | this review only | not stated | not extracted yet | not extracted yet |
| Bosco & Birman, 2002 Oral manifestations in children with AIDS and in controls. PMID:11938722 | this review only | not stated | not extracted yet | not extracted yet |
| Bosco 2002 Oral manifestations in children with AIDS and in controls DOI:10.1590/s1517-74912002000100002 | this review only | not stated | not extracted yet | not extracted yet |
| Bosco 2003 Yeasts from the oral cavity of children with AIDS: exoenzyme production and antifungal resistance DOI:10.1590/s1517-74912003000300004 | this review only | not stated | not extracted yet | not extracted yet |
| Bosco et al., 2003 Yeasts from the oral cavity of children with AIDS: exoenzyme production and antifungal resistance. PMID:14762498 | this review only | not stated | not extracted yet | not extracted yet |
| Cerqueira 2010 Oral<i>Candida</i>colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in… DOI:10.1111/j.1600-0714.2009.00857.x | this review only | not stated | not extracted yet | not extracted yet |
| de Souza 2015 Dental age estimation in Brazilian HIV children using Willems’ method DOI:10.1016/j.forsciint.2015.07.044 | this review only | not stated | not extracted yet | not extracted yet |
| de Souza et al., 2015 Dental age estimation in Brazilian HIV children using Willems' method. PMID:26318404 | this review only | not stated | not extracted yet | not extracted yet |
| Divakar et al., 2015 Oral manifestations in human immunodefi ciency virus infected pediatric patients receiving and not receiving antiretroviral therapy: a… DOI:10.13112/pc.2015.23 | this review only | not stated | not extracted yet | not extracted yet |
| Fernandes 2007 Radiographic evaluation of the chronological development of permanent dentition in children infected with HIV DOI:10.1007/s00784-007-0124-1 | this review only | not stated | not extracted yet | not extracted yet |
| Fernandes et al., 2007 Radiographic evaluation of the chronological development of permanent dentition in children infected with HIV. PMID:17522900 | this review only | not stated | not extracted yet | not extracted yet |
| Holderbaum 2005 Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study DOI:10.1590/s1806-83242005000300010 | this review only | not stated | not extracted yet | not extracted yet |
| Holderbaum et al., 2005 Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study. PMID:16308610 | this review only | not stated | not extracted yet | not extracted yet |
| Pomarico et al., 2009 Associations among the use of highly active antiretroviral therapy, oral candidiasis, oral Candida species and salivary immunoglobulin A… PMID:19615660 | this review only | not stated | not extracted yet | not extracted yet |
| Rajonson 2017 High prevalence of dental caries among HIV‐infected children in <scp>W</scp>est <scp>A</scp>frica compared to uninfected siblings DOI:10.1111/jphd.12203 | this review only | not stated | not extracted yet | not extracted yet |
| Subramaniam 2015 Levels of Salivary Immunoglobulin A (SIgA) in HIV Infected Children DOI:10.17796/1053-4628-39.4.377 | this review only | not stated | not extracted yet | not extracted yet |
| Subramaniam et al., 2015 Levels of Salivary Immunoglobulin A (SIgA) in HIV Infected Children. PMID:26161611 | 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 |
|---|---|---|
| Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review and meta-analysis. (2025) | 3 | 0.09 |