Oral Health Implications in HIV Infection

Oral health in people living with HIV is shaped by intricate interactions between viral infection, immune status and the resident microbial communities of the mouth. HIV-induced immunosuppression predisposes individuals to oral mucosal lesions such as candidiasis, hairy leukoplakia and necrotizing periodontitis, which serve as early indicators of disease progression. Antiretroviral therapy (ART) has transformed HIV into a chronic condition, yet it exerts independent effects on the oral microbiome and local immune responses. Dysbiosis of bacterial and fungal communities in saliva and subgingival plaque contributes to persistent inflammation, periodontal breakdown and caries progression. Emerging evidence suggests that the inflamed gingiva may act as a viral reservoir, complicating eradication efforts. Global studies emphasise the need for integrated dental and medical care, particularly in low- and middle-income settings, to reduce morbidity and improve quality of life for HIV-infected patients.

Research from Nature Portfolio

Recent work has explored the dual impact of HIV infection and first-line integrase strand transfer inhibitors (INSTIs) on the salivary bacteriome. In a cohort comparing ART-naive, INSTI-treated and uninfected controls, overall diversity metrics remained stable across groups, but subtle shifts were detected in key bacterial orders and genera. Naive HIV-positive patients exhibited elevated salivary lysozyme levels and an increased abundance of Acholeplasmatales and Ezakiella species, whereas INSTI treatment partially normalised these profiles. These findings indicate that INSTIs may mitigate—but not fully reverse—HIV-associated oral dysbiosis, highlighting the influence of confounders such as smoking and highlighting the resilience of the oral ecosystem.

Oral Health Implications in HIV Infection publication trend

The graph below shows the total number of articles in oral health implications in hiv infection across all publications each year (not limited to Nature Index journals).

Technical terms

Oral microbiome: The community of bacteria, fungi and viruses inhabiting the mouth.

Dysbiosis: An imbalance in microbial composition linked to disease processes.

Antiretroviral therapy (ART): Drug regimens that suppress HIV replication and restore immune function.

Integrase strand transfer inhibitors (INSTIs): A class of ART that blocks viral DNA incorporation into host genomes.

Gingival reservoir: Oral tissues where HIV may persist despite systemic viral suppression.

References

1. HIV Infection and Compromised Mucosal Immunity: Oral Manifestations and Systemic Inflammation. Frontiers in Immunology (2017).
2. Beyond the effects of HIV infection and integrase inhibitors-based therapies on oral bacteriome. Scientific Reports (2023).
3. Independent Effects of HIV and Antiretroviral Therapy on the Oral Microbiome Identified by Multivariate Analyses. mBio (2023).
4. Human immunodeficiency virus and oral microbiota: mutual influence on the establishment of a viral gingival reservoir in individuals under antiretroviral therapy. Frontiers in Cellular and Infection Microbiology (2024).
5. HIV-Related Oral Mucosa Lesions: A Cross-Sectional Study on a Cohort of Italian Patients. Biomedicines (2024).
6. Integrating Oral Health Within Kenyan HIV Research & Policy Structure: Stakeholder Analysis. Annals of Global Health (2024).