Non-Cochrane · aetiology · PM40349034
Association between antiretroviral therapy and dental caries in children and adolescents with HIV: a systematic review and meta-analysis.
Aguirre-Ipenza Rubén, Bautista-Pariona Anthony, Viguria-Chavez Yolanda, et al. · BMC oral health · 2025 · PubMed · doi:10.1186/s12903-025-06015-0
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
19
current version
GRADE rated
7
No studies
0
Included studies
17
linked below
No studies 0 · 0%Ungraded 12 · 63.2%Very low 7 · 36.8%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 under 18 years with HIV | Children and adolescents with HIV on ART (17 included studies: 9 cross-sectional, 6 case-control, 2 cohort; 15 studies contributed to the meta-analysis) |
| Intervention | HIV diagnosis with receipt of antiretroviral therapy (ART; includes HAART/>=3 drugs and standard ART/s-ART) as the exposure | Antiretroviral therapy (HAART and/or standard ART) (n=17 studies) |
| Comparison | Individuals without HIV, or HIV-positive individuals who had not received antiretroviral therapy | HIV-negative individuals (main comparator); also HIV-positive not on HAART, HIV-exposed uninfected (HEU), and HIV-unexposed uninfected (HUU) |
| Outcomes | Dental caries: presence/absence and severity, measured numerically (e.g., DMFT/dmft, DMFS/dmfs indices) or categorically | Dental caries presence (odds ratio) and caries severity indices DMFT, dmft, DMFS, dmfs (mean difference), pooled with a random-effects model and stratified by study design; certainty rated Very Low (GRADE) for the seven Summary-of-Findings outcomes |
| Study designs | Comparative observational studies (cohort, case-control, cross-sectional); review studies, conference abstracts, case reports, and animal/ex vivo studies excluded | 9 cross-sectional, 6 case-control, 2 cohort studies (15 in meta-analysis) |
| Timing | Not specified (no restriction on follow-up duration, language, publication date, or sample size) | Not specified (cross-sectional and observational designs; participant ages 6 months to 24 years) |
Search date: Inception to October 2024 (LILACS expanded search updated February 2025). Databases: PubMed (Medline); Scopus; Cochrane Library (CENTRAL); EMBASE; LILACS; grey literature via OpenGrey and Google Scholar (first 100 results each); reference lists; manual search of key HIV and dentistry journals
Questions and results
HIV infection with antiretroviral therapy (ART/HAART) vs HIV-negative individuals
Population: Children and adolescents under 18 years with HIV
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries severity (dmfs index, primary dentition) Not specified (case-control) · Case-control studies; dmfs index In case-control studies, HIV+ children on ART had a significantly higher dmfs index than HIV-negative peers (MD 5.15, 95% CI 2.20 to 8.11; not separately GRADE-rated). Source: Results 'DMFS and dmfs in HIV-positive patients vs HIV-negative' (Fig. 7) · same question in other reviews | MD 5.15 [2.20, 8.11] 5.15 [2.20, 8.11] points higher (dmfs) | 2 studies · 185 participants | Ungraded |
Dental caries severity (DMFT index, permanent dentition) Not specified (case-control) · Case-control studies; DMFT index In case-control studies, HIV+ children on ART had a significantly higher DMFT index than HIV-negative peers (MD 0.85, 95% CI 0.04 to 1.66; very low certainty). Source: Table 4 (Summary of findings); Results 'DMFT and dmft in HIV-positive patients vs HIV-negative' (Fig. 6) · same question in other reviews | MD 0.85 [0.04, 1.66] 0.85 [0.04, 1.66] points higher (DMFT) | 2 studies · 204 participants | Very low Downgraded: inconsistency, indirectness |
Dental caries severity (dmfs index, primary dentition) Not specified (cross-sectional) · Cross-sectional studies; dmfs index In cross-sectional studies, HIV+ children on ART had a significantly higher dmfs index than HIV-negative peers (MD 4.00, 95% CI 2.64 to 5.36; not separately GRADE-rated). Source: Results 'DMFS and dmfs in HIV-positive patients vs HIV-negative' (Fig. 7) · same question in other reviews | MD 4.00 [2.64, 5.36] 4.00 [2.64, 5.36] points higher (dmfs) | 1 study · 564 participants | Ungraded |
Dental caries (presence/absence) Not specified (cross-sectional) · Cross-sectional studies In cross-sectional studies, children and adolescents with HIV on antiretroviral therapy had about twice the odds of dental caries versus HIV-negative peers (OR 2.04, 95% CI 1.21 to 3.42; very low certainty). Source: Table 4 (Summary of findings); Results 'Quantitative analysis: results synthesis' (Fig. 4) · same question in other reviews | OR 2.04 [1.21, 3.42] 163 [46, 255] per 1,000 (risk difference) | 6 studies · 2206 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Dental caries (presence/absence) Not specified (case-control) · Case-control studies A single case-control study found no significant difference in the odds of dental caries between HIV+ children on ART and HIV-negative peers (OR 3.15, 95% CI 0.98 to 10.15; very low certainty). Source: Table 4 (Summary of findings); Results 'Quantitative analysis: results synthesis' (Fig. 4) · same question in other reviews | OR 3.15 [0.98, 10.15] 182 [-4, 262] per 1,000 (risk difference) | 1 study · 99 participants | Very low Downgraded: imprecision, indirectness |
Dental caries severity (DMFT index, permanent dentition) Not specified (cross-sectional) · Cross-sectional studies; DMFT index In cross-sectional studies, the DMFT index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 0.60, 95% CI -0.53 to 1.72; very low certainty). Source: Table 4 (Summary of findings); Results 'DMFT and dmft in HIV-positive patients vs HIV-negative' (Fig. 6) · same question in other reviews | MD 0.60 [-0.53, 1.72] 0.60 [-0.53, 1.72] points higher (DMFT) | 4 studies · 1390 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Dental caries severity (dmft index, primary dentition) Not specified (cross-sectional) · Cross-sectional studies; dmft index In cross-sectional studies, the dmft (primary dentition) index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 0.92, 95% CI -0.09 to 1.93; very low certainty). Source: Table 4 (Summary of findings); Results 'DMFT and dmft in HIV-positive patients vs HIV-negative' (Fig. 6) · same question in other reviews | MD 0.92 [-0.09, 1.93] 0.92 [-0.09, 1.93] points higher (dmft) | 5 studies · 1502 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Dental caries severity (dmft index, primary dentition) Not specified (case-control) · Case-control studies; dmft index In case-control studies, HIV+ children on ART had a higher dmft (primary dentition) index than HIV-negative peers (MD 1.53, 95% CI 1.39 to 1.67; very low certainty). Source: Table 4 (Summary of findings); Results 'DMFT and dmft in HIV-positive patients vs HIV-negative' (Fig. 6) · same question in other reviews | MD 1.53 [1.39, 1.67] 1.53 [1.39, 1.67] points higher (dmft) | 2 studies · 185 participants | Very low Downgraded: inconsistency, indirectness |
Dental caries severity (DMFS index, permanent dentition) Not specified (cross-sectional) · Cross-sectional studies; DMFS index In cross-sectional studies, HIV+ children on ART had a significantly higher DMFS index than HIV-negative peers (MD 2.00, 95% CI 1.54 to 2.46; not separately GRADE-rated). Source: Results 'DMFS and dmfs in HIV-positive patients vs HIV-negative' (Fig. 7) · same question in other reviews | MD 2.00 [1.54, 2.46] 2.00 [1.54, 2.46] points higher (DMFS) | 1 study · 778 participants | Ungraded |
Dental caries severity (DMFS index, permanent dentition) Not specified (case-control) · Case-control studies; DMFS index In case-control studies, the DMFS index did not differ significantly between HIV+ children on ART and HIV-negative peers (MD 1.10, 95% CI -0.25 to 2.45; not separately GRADE-rated). Source: Results 'DMFS and dmfs in HIV-positive patients vs HIV-negative' (Fig. 7) · same question in other reviews | MD 1.10 [-0.25, 2.45] 1.10 [-0.25, 2.45] points higher (DMFS) | 1 study · 105 participants | Ungraded |
Dental caries (presence/absence) Prospective follow-up (single cohort) · Cohort studies In a single cohort study, children with HIV on antiretroviral therapy had higher odds of dental caries than HIV-negative peers (OR 2.15, 95% CI 1.48 to 3.12; very low certainty). Source: Table 4 (Summary of findings); Results 'Quantitative analysis: results synthesis' (Fig. 4); Abstract · same question in other reviews | OR 2.11 [1.41, 3.17] 145 [68, 233] per 1,000 (risk difference) | 1 study · 544 participants | Very low Downgraded: indirectness |
HAART (highly active antiretroviral therapy, >=3 drugs) vs HIV-positive not receiving HAART (standard ART or HAART-naive)
Population: Children and adolescents under 18 years with HIV
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (presence/absence) Not specified (cross-sectional) · Cross-sectional studies; DMFT index Among HIV+ children, HAART versus no HAART showed no significant difference in the odds of dental caries by DMFT in cross-sectional studies (OR 1.29, 95% CI 0.59 to 2.84; ungraded). Source: Results 'Impact of HAART on dental caries' (Fig. 8) · same question in other reviews | OR 1.29 [0.59, 2.84] | NR | Ungraded |
Dental caries (presence/absence) Not specified (cross-sectional) · Cross-sectional studies; deft index Among HIV+ children, HAART versus no HAART showed no significant difference in the odds of dental caries by deft in cross-sectional studies (OR 1.09, 95% CI 0.65 to 1.82; ungraded). Source: Results 'Impact of HAART on dental caries' (Fig. 8) · same question in other reviews | OR 1.09 [0.65, 1.82] | NR | Ungraded |
Dental caries severity (DMFT index, permanent dentition) Not specified (case-control) · Case-control studies; DMFT index Among HIV+ children, HAART was associated with a significantly higher DMFT index than no HAART in case-control studies (MD 2.02, 95% CI 1.24 to 2.80; ungraded). Source: Results 'Impact of HAART on dental caries' (Fig. 10) · same question in other reviews | MD 2.02 [1.24, 2.80] 2.02 [1.24, 2.80] points higher (DMFT) | NR | Ungraded |
Dental caries severity (dmft index, primary dentition) Not specified (case-control) · Case-control studies; dmft index Among HIV+ children, HAART versus no HAART showed no significant difference in the dmft index in case-control studies (MD 0.66, 95% CI -0.26 to 1.58; ungraded). Source: Results 'Impact of HAART on dental caries' (Fig. 10) · same question in other reviews | MD 0.66 [-0.26, 1.58] 0.66 [-0.26, 1.58] points higher (dmft) | NR | Ungraded |
HIV-infected children on antiretroviral therapy (HI) vs HIV-exposed but uninfected children (HEU)
Population: Children and adolescents under 18 years with HIV
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (presence/absence) Not specified (cross-sectional) · Cross-sectional studies HIV-infected children on ART had higher odds of dental caries than HIV-exposed uninfected (HEU) children in cross-sectional studies (OR 3.73, 95% CI 1.88 to 7.40; ungraded). Source: Results 'Comparison with other control groups (HEU and HUU)' (Suppl. Mat. 1) · same question in other reviews | OR 3.73 [1.88, 7.40] | NR | Ungraded |
Dental caries (presence/absence) Prospective follow-up · Cohort studies HIV-infected children on ART had higher odds of dental caries than HEU children in a cohort study (OR 2.88, 95% CI 1.71 to 4.84; ungraded). Source: Results 'Comparison with other control groups (HEU and HUU)' (Suppl. Mat. 1) · same question in other reviews | OR 2.88 [1.71, 4.84] | NR | Ungraded |
HIV-infected children on antiretroviral therapy (HI) vs HIV-unexposed uninfected children (HUU)
Population: Children and adolescents under 18 years with HIV
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (presence/absence) Not specified (case-control) · Case-control studies HIV-infected children on ART had higher odds of dental caries than HUU children in case-control studies (OR 1.61, 95% CI 1.02 to 2.56; ungraded). Source: Results 'Comparison with other control groups (HEU and HUU)' (Suppl. Mat. 1) · same question in other reviews | OR 1.61 [1.02, 2.56] | NR | Ungraded |
Dental caries (presence/absence) Not specified (cross-sectional) · Cross-sectional studies HIV-infected children on ART showed a non-significant higher odds of dental caries versus HIV-unexposed uninfected (HUU) children in cross-sectional studies (OR 1.80, 95% CI 0.98 to 3.28; ungraded). Source: Results 'Comparison with other control groups (HEU and HUU)' (Suppl. Mat. 1) · same question in other reviews | OR 1.80 [0.98, 3.28] | NR | Ungraded |
Included primary studies 17
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Cerqueira 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 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 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 |
| Akhigbe 2022 Age-specific associations with dental caries in HIV-infected, exposed but uninfected and HIV-unexposed uninfected children in Nigeria. PMID:36167498 | this review only | not stated | not extracted yet | not extracted yet |
| Andrade 2016 Molar incisor hypomineralization in HIV-infected children and adolescents. PMID:27791275 | this review only | not stated | not extracted yet | not extracted yet |
| Castro 2004 Salivary IgA to cariogenic bacteria in HIV-positive children and its correlation with caries prevalence and levels of cariogenic… PMID:15327638 | this review only | not stated | not extracted yet | not extracted yet |
| Coker 2018 Perinatal HIV Infection and Exposure and Their Association With Dental Caries in Nigerian Children. PMID:28746260 | this review only | not stated | not extracted yet | not extracted yet |
| de Jesus 2017 Influence of Caregiver's Sociodemographic Background on the Oral Health Status and Care of HIV-infected Children. PMID:28387185 | this review only | not stated | not extracted yet | not extracted yet |
| Ferreira 2018 Oral Status and Periodontal Microbiota of HIV-infected Youth Infected By Vertical Transmission DOI:10.2217/fvl-2018-0025 | this review only | not stated | not extracted yet | not extracted yet |
| Gainneos 2021 A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age… DOI:10.31782/ijcrr.2021.sp142 | this review only | not stated | not extracted yet | not extracted yet |
| Kikuchi 2021 Oral health among HIV-positive and HIV-negative children in Phnom Penh, Cambodia: a cross-sectional study. PMID:33782657 | this review only | not stated | not extracted yet | not extracted yet |
| Kumar 2024 HAART medication and oral health status in children and adolescent HIV infected: A case control study. PMID:37984407 | this review only | not stated | not extracted yet | not extracted yet |
| O'Connell 2023 Supragingival mycobiome of HIV-exposed-but-uninfected children reflects a stronger correlation with caries-free-associated taxa compared… PMID:37874172 | this review only | not stated | not extracted yet | not extracted yet |
| Oliscovicz 2015 Effect of highly active antiretroviral therapy use on oral manifestations in pediatric patients infected with HIV. PMID:26096118 | this review only | not stated | not extracted yet | not extracted yet |
| Rwenyonyi 2011 Oral Manifestations in HIV/AIDS-Infected Children. PMID:21769270 | this review only | not stated | not extracted yet | not extracted yet |
| Shrikanth 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Thejashwini 2018 DOI:10.9790/0853-1701130106 | 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 |
|---|---|---|
| Oral Health Status of Children and Adolescents Living with HIV Undergoing Antiretroviral Therapy: A Systematic Review and Meta-Analysis. (2022) | 3 | 0.09 |