Pediatric Oral HIV Research in the Developing World

Africa, Asia, Brazil and the Caribbean remain the epicenter of the HIV/AIDS pandemic. Sub-Saharan Africa carries the burden of pediatric HIV/AIDS infections with an estimated 1,8 million infected children i.e. 8.2% of the total population at the end of 2007. This presentation will focus on pediatric HIV oral lesions as predictors of HIV infection, markers of the efficacy of HAART, quality of life and caries risk, the management of oral lesions and the use of epidemiological tests to determine the clinical significance of oral lesions. The prevalence of oral lesions among children constitute < 10% of all prevalence studies related to oral HIV; oral lesions remain useful predictors for HIV infection with studies reporting that multiple rather than single lesions as more reliable indicators of progression. Oral lesions have moderate sensitivity, high specificity and a positive predictive value when predicting immune failure but low sensitivity, a positive predictive value and high specificity when predicting virologic failure among children on HAART. Oral lesions associated with HIV affect the quality of life in adults but little data exists for children. Evidence suggests that caries risk increases with HIV infection. The management of oral lesions is inconsistent with available resources while measures such as Odds and Likelihood ratios which provide more information on clinical outcome are not being optimally used to highlight the importance and value of oral HIV lesions. In conclusion, pediatric oral HIV research remains hampered by poor quality study designs, small study samples and the lack of multicenter collaborations that can provide quality data which will significantly influence key aspects of pediatric oral HIV research.