Ropivacaine HCl synthesis br Discussion In our study
Discussion In our study the prevalence of severe periodontitis in patients with HIV infection was 66%, almost twice as high as in uninfected controls. Our results are in line with the prevalence of severe periodontitis found in HIV-infected patients in London, United Kingdom in the pre-cART era: 60% compared to 29% in controls. In a more recent German study, however, the prevalence of severe periodontitis in HIV infected patients was considerably lower, i.e. 30%, although the latter study did not specify any definition of severe periodontitis, making it impossible to compare both results. Moreover, with the exception of the aforementioned study by Robinson et al., none of the studies included a comparable control group, hampering any conclusions on periodontitis prevalence and severity in HIV patients as compared to controls. Gender, age, the interaction term age x age and HIV infection, were the risk factors of severe periodontitis in the statistical analysis. Interestingly, we detected that the risk of severe periodontitis increased till the age of approximately 55 years and declined thereafter. This trend is in Ropivacaine HCl synthesis to the general perception that the prevalence of severe periodontitis continuously increases with age. As age increases, teeth may be lost due to severe periodontitis, thus masking an increasing prevalence of severe periodontitis with age. Moreover, with increasing age, dentists may be more prone to remove teeth affected by severe periodontitis. As tooth loss in elderly patients is often considered a natural process, this shift in attitude towards extraction of teeth may also mask an increasing prevalence of periodontitis with age. Another explanation might be that the statistical model used in our study did not precisely estimate the risk of severe periodontitis in older ages due to the limited number of participants older than 65. HIV-infected men appear to have a higher risk of developing severe periodontitis than HIV-infected women. This finding is in accordance with a previous study in HIV infected patients in Brazil where the prevalence of periodontitis was 30% for men and 20% for women. In general the cause of gender differences in the prevalence of periodontitis is not fully understood. It is postulated that oral hygiene level in males is poorer than in females or that hormonal, physiological and behavioral differences, for instance more males smoke than females, may play a role.2, 38 Interestingly, we found that HIV-infected women had the same prevalence of severe periodontitis as male HIV-uninfected controls. Our study shows that HIV-infected patients rate the importance of their oral health as very high, but many HIV infected patients do not inform their dentists about HIV infection. This failure to inform their dentist could be due to several factors. Fear of refusal of dental treatment or fear of stigmatization are probably the most common reasons for not disclosing HIV infection. Indeed, dentists’ concerns regarding increased personal risk is the most frequently reported reason for their reluctance to treat HIV-infected patients. Increased awareness of healthcare professionals about the higher prevalence of periodontitis in HIV-infected patients and could significantly improve oral health and thus the quality of life of HIV-infected patients. Patients with HIV infection are known to have a significantly higher prevalence of age-associated diseases, like hypertension, diabetes mellitus, obstructive pulmonary disease and renal dysfunction. It is postulated that the increased prevalence of cardiovascular diseases in HIV patients is due to activation of the immune system. Specifically, macrophages and monocytes activation, which play a significant role in atherogenesis, in combination with deregulation of CD8 + T-cells, are associated with higher values of carotid intimal media thickness and arterial stiffness Likewise, HIV and periodontitis could interact and promote development of age-associated diseases.23, 42 We could not confirm that diabetes and cardiovascular diseases were significant risk factors for periodontitis in our HIV-infected patients, however. Further exploration of the relationship between periodontitis and HIV-related immune activation as a prognostic determinant of age-associated diseases is desirable.