Longitudinal Predictors of Dental Caries, Periodontal Disease and Oral Health Quality of Life in People with HIV on ART: The OHART study

Background: Oral diseases are prevalent among people with HIV (PWH) receiving antiretroviral therapy (ART), yet longitudinal data on oral health outcomes and oral health-related quality of life (OHQoL) in this group are limited. This study investigates the longitudinal associations among demographic, clinical, and behavioral factors and oral health outcomes, as well as their impact on OHQoL in PWH on ART. Methods: In this two-year prospective observational study, 227 PWH on ART participated in five visits at 6-month intervals. We collected data on demographics; socioeconomic status; HIV history; ART; lifestyle risk factors such as tobacco, alcohol and recreational drug use; saliva flow rate; dental caries (DMFT and MT indices) and periodontal disease (clinical attach loss-CAL, Bleeding on probing-BOP and pocket depth-PD); OHQoL based on NHANES Oral Health Survey; and xerostomia-related quality of life. We used the generalized estimating equations version of linear regression to quantify associations among these factors. Results: DMFT (β = 1.05; p < 0.001) and MT (β = 0.89; p = 0.006) significantly increased with increasing age, among Blacks (DMFT: β = 3.25, p = 0.002; MT: β = 3.60, p = 0.003), and with increasing duration of HIV (p = 0.014). Higher salivary flow rate was associated with lower DMFT (p = 0.002) and MT (p < 0.001) scores, whereas bictegravir treatment was associated with increased DMFT (p = 0.046). Longer HIV duration correlated with decreased clinical attachment loss (p = 0.005), bleeding on probing (BOP; p = 0.036) and pocket depth (0.003). Bictegravir use was also correlated with decreased CAL (p = 0.019) and BOP% (p = 0.035). Hispanics showed reduced BOP (p = 0.010) when compared with non-Hispanics. Higher DMFT scores were associated with decreased OHQoL (p = 0.003). Conclusion: Adult PWH on ART have a high risk of dental caries and tooth loss, with hyposalivation/xerostomia contributing to lower OHQoL. While periodontal outcomes appeared favorable among individuals with longer HIV duration, aging, smoking, and specific ART exposures influenced oral health trajectories.These findings emphasize the importance of integrating oral health care into HIV treatment models and highlights the importance of addressing salivary dysfunction and caries risk in aging populations with HIV