Non-Cochrane · intervention · PM41913164
Oral manifestations in HIV-positive individuals under highly active antiretroviral therapy: a systematic review and meta-analysis of prevalence data.
Dagnoni Thais Suzigan, Paranhos Luiz Renato, de Almeida Vinícius Lima, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08182-0
Findings
13 findings
| Population | ||||
|---|---|---|---|---|
| HIV-positive adults receiving HAART | HAART (single-group prevalence) | None | Prevalence of oral mucosa hyperpigmentation HIV-positive adults in clinical settings (16 countries) | Prevalence (%) 16.2 [7.7, 27.0] GRADE not reported 13 studies · 2210 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Recurrent oral ulceration | Prevalence (%) 4.0 [1.8, 6.7] GRADE not reported 19 studies · 5679 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Angular cheilitis | Prevalence (%) 3.8 [2.3, 5.5] GRADE not reported 14 studies · 4561 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Oral hairy leukoplakia | Prevalence (%) 3.8 [1.9, 6.2] GRADE not reported 21 studies · 5510 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Erythematous candidiasis | Prevalence (%) 8.0 [3.9, 13.2] GRADE not reported 15 studies · 4241 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Kaposi's sarcoma | Prevalence (%) 1.2 [0.5, 2.2] GRADE not reported 12 studies · 4365 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Herpes simplex | Prevalence (%) 1.2 [0.4, 2.2] GRADE not reported 13 studies · 4358 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Salivary gland diseases | Prevalence (%) 3.9 [1.6, 7.1] GRADE not reported 8 studies · 1276 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Any oral manifestation | Prevalence (%) 42 [29, 56] GRADE not reported 13 studies · 1778 participants |
| HIV-positive adults receiving HAART | HAART (single-group prevalence) | None | Prevalence of pseudomembranous candidiasis HIV-positive adults in clinical settings (16 countries) | Prevalence (%) 7.1 [2.8, 13.0] GRADE not reported 15 studies · 4299 participants |
| HIV-positive adults receiving HAART | HAART (exposure) | None (single-group prevalence) | Necrotizing ulcerative gingivitis | Prevalence (%) 2.3 [1.3, 3.6] GRADE not reported 9 studies · 3504 participants |
| HIV-positive adults | HAART | No HAART | Any oral manifestation Sensitivity analysis excluding high-risk-of-bias studies | OR 0.74 [0.24, 2.24] GRADE not reported 3 studies · 855 participants |
| HIV-positive adults | HAART | No HAART | Any oral manifestation | OR 0.51 [0.27, 0.94] -165 [-299, -15] per 1000 Very low Downgraded: inconsistency 6 studies · 1526 participants |
Included primary studies 25
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Abe 2021 Orofacial lesions associated with long-term highly active antiretroviral therapy among HIV-seropositive adults in Ibadan, Nigeria. PMID:34367449 | 2021 | this review only | Any oral manifestation | not extracted yet |
| Arirachakaran 2016 Highly-active antiretroviral therapy and oral opportunistic microorganisms in HIV-positive individuals of Thailand. PMID:25537925 | 2016 | this review only | not stated | not extracted yet |
| Bartholo 2023 Orofacial manifestations in Brazilian people living with HIV/AIDS under long-term antiretroviral therapy: a cross-sectional study. PMID:37271609 | 2023 | this review only | Any oral manifestation | not extracted yet |
| Casariego 2012 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Cepeda 2008 Oral lesions and immune reconstitution syndrome in HIV+/AIDS patients receiving highly active antiretroviral therapy. Epidemiological… PMID:18223535 | 2008 | this review only | not stated | not extracted yet |
| Denny 2016 Oral Lesions in HIV/AIDS Patients on a highly Active Antiretroviral Therapy DOI:10.5005/jp-journals-10015-1373 | 2016 | this review only | not stated | not extracted yet |
| Dongade 2018 Prevalence of Oral Manifestations Among HIV-Positive Patients Undergoing Antiretroviral Treatment Visiting Chamarajanagar District… DOI:10.4103/jiaomr.jiaomr_111_17 | 2017 | this review only | not stated | not extracted yet |
| Eweka 2012 Prevalence of oral lesions and the effects of HAART in adult HIV patients attending a tertiary hospital in Lagos, Nigeria DOI:10.4236/ojst.2012.23036 | 2012 | this review only | Any oral manifestation | not extracted yet |
| Eyeson 2002 Oral manifestations of an HIV positive cohort in the era of highly active anti-retroviral therapy (HAART) in South London. PMID:11903824 | 2002 | this review only | not stated | not extracted yet |
| Freeman 2012 Oral health in Australian HIV patients since the advent of combination antiretroviral therapy. PMID:23186573 | 2012 | this review only | Any oral manifestation | not extracted yet |
| Hamza 2006 Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam,… PMID:16916469 | 2006 | this review only | not stated | not extracted yet |
| Jane-Salas 2006 Efecto de los tratamientos antirretrovirales en las manifestaciones orales de los pacientes VIH+ DOI:10.4321/s0213-12852006000600003 | 2006 | this review only | not stated | not extracted yet |
| Kroidl 2005 Prevalence of oral lesions and periodontal diseases in HIV-infected patients on antiretroviral therapy. PMID:16287607 | 2005 | this review only | Any oral manifestation | not extracted yet |
| Lourenco 2008 Oral lesions in HIV infected individuals from Ribeirão Preto, Brazil. PMID:18449110 | 2008 | this review only | Any oral manifestation | not extracted yet |
| Mthethwa 2013 The prevalence of HIV associated oral lesions among adults in the era of HAART. PMID:24660404 | 2013 | this review only | Any oral manifestation | not extracted yet |
| Naidu 2013 Oral lesions and immune status of HIV infected adults from eastern Nepal. PMID:24455044 | 2013 | this review only | not stated | not extracted yet |
| Nicolatou-Galitis 2004 Effect of PI-HAART on the prevalence of oral lesions in HIV-1 infected patients. A Greek study. PMID:15089923 | 2004 | this review only | not stated | not extracted yet |
| Nittayananta 2010 Effects of long-term use of HAART on oral health status of HIV-infected subjects. PMID:20202089 | 2010 | this review only | Any oral manifestation | not extracted yet |
| Ortega 2008 Oral manifestations after immune reconstitution in HIV patients on HAART. PMID:18482959 | 2008 | this review only | Any oral manifestation | not extracted yet |
| Patil 2015 The effect of highly active antiretroviral therapy on the prevalence of oral manifestation in human immunodeficiency virus-infected… PMID:25713484 | 2015 | this review only | Any oral manifestation | not extracted yet |
| Perera 2012 Prevalence of oral mucosal lesions in adults undergoing highly active antiretroviral therapy in Hong Kong. PMID:22573355 | 2012 | this review only | Any oral manifestation | not extracted yet |
| Rao 2015 Impact of highly active antiretroviral therapy on oral manifestations of patients with human immunodeficiency virus/acquired immuno… PMID:26392652 | 2015 | this review only | not stated | not extracted yet |
| Ricardo 2012 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Taiwo 2010 The impact of Highly Active Antiretroviral Therapy (HAART) on the clinical features of HIV - related oral lesions in Nigeria. PMID:20579347 | 2010 | this review only | Any oral manifestation | not extracted yet |
| Tappuni 2001 The effect of antiretroviral therapy on the prevalence of oral manifestations in HIV-infected patients: a UK study. PMID:11740479 | 2001 | this review only | Any oral manifestation | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | HIV-positive adults (children only samples excluded) | HIV-positive adults in 16 countries (n=25 studies; sample sizes 72 to 2611) |
| Intervention | HAART (monotherapy, non-HAART antiretroviral therapy and antifungal treatment excluded) | HAART (time on HAART from 1 month to over 20 years where reported) |
| Comparison | HIV-positive patients not receiving HAART; before versus after HAART | HIV-positive patients without HAART (11 studies with both groups); before-after HAART (3 studies); HAART only (11 studies) |
| Outcomes | Prevalence of oral lesions/manifestations | Prevalence of any oral manifestation and of ten individual manifestations (pseudomembranous and erythematous candidiasis, angular cheilitis, herpes simplex, Kaposi sarcoma, oral hairy leukoplakia, mucosal hyperpigmentation, recurrent ulceration, salivary gland disease, necrotizing ulcerative gingivitis); OR of oral manifestations HAART vs no HAART |
| Study designs | Observational studies (cross-sectional, before-after) | 25 observational studies (22 cross-sectional, 3 before-after); 13 in prevalence meta-analysis, 6 in HAART vs no HAART comparison |
| Timing | Not specified | Not specified |
AMSTAR 2 items
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 | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Yes | RCT: N/A · NRSI: Partial Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: Partial Yes | RCT: N/A · NRSI: No | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Moderate | Low | no |