RESUMEN
Background: Chronic periodontitis (CP), caused by bacteria and fungi, appears in up to 66% of HIV-patients. The impact and association of HIV-treatment (HAART) and Candida itself has not been properly evaluated in the development and progression of CP. The immunopathogenesis is characterized by CD4+ T-cells activation and the balance between the T-helper 1 (Th1) and T-helper 2 (Th2) or a mixed cytokine profile. Currently, the associated causes of an immune response in HIV-patients with CP is controversial. Our aims were the determination of Candida spp. and cytokine profile in oral samples from HIV-positive patients with CP, considering the CD4+ T cells levels and HAART use. Methods: From 500 HIV-positive patients evaluated, 228 patients were enrolled. Patients were separated in groups: (A) n = 53 (≤200 CD4+ T-cells on HAART); (B) n = 57 (≤200 CD4+ T-cells without HAART); (C) n = 50 (>200 CD4+ T-cells without HAART); (D) n = 68 (>200 CD4+ T-cells on HAART). Candida spp. were isolated from the oral biofilm and crevicular fluid in CHROMagar and confirmed by endpoint PCR. Cytokine levels were measured by beads-based immunoassay in saliva by flow cytometry. Results: 147 patients (64.5%) were positive to Candida spp. and 204 strains were isolated; 138 (67.6%) were C. albicans and the remaining C. non-albicans species (C. glabrata>C. tropicalis>C. krusei>C. dubliniensis). In this study, CHROMagar showed good sensitivity (95%) but poor specificity (68%); since of the 152 samples identified as C. albicans, only 131 were confirmed by PCR; from the 10 samples identified as C. glabrata, only six were confirmed. Finally, of the 42 samples detected as C. tropicalis, only five were confirmed. When evaluating Candida spp. presence, group A and D had higher isolation, while group B had the highest species diversity. Whereas, group C had a significant reduction of Candida spp. Despite the presence of Candida and HAART, we found a Th1/Th2 hybrid profile in the saliva of patients with low CD4+ T-cell count (group A). Conclusion: Abundance and diversity of the Candida spp. detected in HIV-patients with CP could be related to HAART and low CD4+ T-cells levels. Also, the immunosuppression might promote a local Th1/Th2 hybrid cytokine profile.
Asunto(s)
Candida/inmunología , Candidiasis Bucal/inmunología , Periodontitis Crónica/inmunología , Citocinas/inmunología , Infecciones por VIH/inmunología , Células TH1/inmunología , Células Th2/inmunología , Adulto , Terapia Antirretroviral Altamente Activa , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , Candida/clasificación , Candida/fisiología , Candidiasis Bucal/microbiología , Periodontitis Crónica/microbiología , Periodontitis Crónica/virología , Citocinas/metabolismo , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Saliva/efectos de los fármacos , Saliva/inmunología , Saliva/metabolismo , Especificidad de la Especie , Células TH1/microbiología , Células TH1/virología , Células Th2/microbiología , Células Th2/virologíaRESUMEN
RESUMEN Antecedentes: A nivel mundial la población envejecida está aumentando y esto es seguido por un aumento en resultados negativos llamados síndromes geriátricos (SG). Un elemento clave del envejecimiento exitoso es la salud oral (SO). La alteración en los componentes de OH, como la presencia de xerostomía, se ha asociado con una mayor probabilidad de desarrollar algunos SG. Objetivos: Determinar la prevalencia de la xerostomía y sus asociaciones entre las características sociodemográfi cas, el estado de salud y algunos GS en adultos de 60 años o más, que asisten a consulta de primer nivel en México. Material y métodos: Estudio transversal en participantes de 60 años o más, reclutados en 2016. Los participantes se sometieron a una evaluación geriátrica integral (EGI), con la que se obtuvo el diagnóstico de xerostomía y SG. Se determinaron los análisis de regresión ajustados por las variables de confusión para establecer la asociación entre la xerostomía, las características sociodemográfi cas y algunos SG. Resultados: Se incluyeron 264 sujetos; la edad media fue de 73 años (DE ± 6), las mujeres representaron el 60%. En general, el 33% informó la presencia de xerostomía. Después de ajustar por edad, sexo y lectoescritura, los análisis de regresión logística múltiple mostraron una asociación signifi cativa entre la xerostomía y algunos SG (depresión y dolor). Conclusión: Este estudio mostró que la prevalencia de xerostomía es mayor en ancianos mexicanos. Estos resultados sugieren la importancia de monitorear el deterioro de la salud oral, ya que la xerostomía parece tener una infl uencia negativa en el estado de salud de los ancianos, y que la evaluación de la xerostomía debe incluirse en la evaluación geriátrica para prevenir los SG.
ABSTRACT Background: Worldwide aged population is increasing and this is followed by an increase a in negative outcome called geriatric syndromes (GS). A key element of a successful aging is oral health (OH). Alteration of OH components, such as the presence of xerostomia, have been associated with a higher probability of develop some GS. Objectives: Determine the prevalence of xerostomia and its associations between the sociodemographic characteristics, the state of health and some GS in adults of 60 years or older, who attend fi rst level consultation in Mexico. Material and methods: Transverse study in participants of 60 years or more, recruited in 2016. The participants underwent an integral geriatric evaluation (IGE), with which the diagnosis of xerostomia and GS was obtained. The adjusted regression analysis were determined by the confounding variables to establish the association between xerostomia, sociodemographic characteristics and some GS. Results: 264 subjects were included; the average age was 73 years (SD ± 6), women accounted for 60%. In general, 33% reported the presence of xerostomia. After adjusting for age, sex and literacy, multiple logistic regression analysis showed a signifi cant association between xerostomia and some GS (depression and pain). Conclusion: This study showed that the prevalence of xerostomia is higher in mexican elderly. These results suggest the importance of monitoring the deterioration of oral health, since xerostomia seems to have a negative infl uence on the state of health of the elderly and that the evaluation of xerostomia should be included in the geriatric assessment to prevent GS.