Avaliação de manifestações orais e a percepção sobre o atendimento odontológico em pessoas vivendo com HIV em tratamento antirretroviral

Abstract

HIV infection is characterized by immunosuppression and present manifestations in the head region, including oral lesions that may be the first clinical signs of infection. These manifestations may indicate immunological deterioration and disease progression. This dissertation aimed to evaluate oral manifestations and the perception of dental care in people living with HIV (PLHIV) undergoing antiretroviral treatment. A mixed-type study was carried out, divided into two chapters. The first chapter refers to a quantitative study, which aimed to assess the prevalence of oral lesions in patients living with HIV infection and its association with CD4 count, viral load, and antiretroviral therapy. The second chapter has a qualitative design, to assess, under the perception of PLHIV, the occurrence of discriminatory attitudes regarding dental care. Oral manifestations were observed in 58.39% of patients. Periodontal disease with or without mobility, 78 (48.45%) and 79 (49.07%), respectively, was most frequently observed, followed by hyperpigmentation of the oral mucosa 23 (14.29%), linear gingival erythema (LGE) 15 (9.32%), pseudomembranous candidiasis 14 (8.70%). A relationship was found between periodontal disease and tooth mobility and smoking (p = 0.04), as well as duration of treatment (p = 1.53e-3) and age (p = 0.02). Hyperpigmentation was related to race (p = 0.01) and smoking (p = 1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral manifestations. Logistic regression showed that treatment time has a protective effect on the periodontal disease with tooth mobility ([OR = 0.28 (-2.27--0.25); p-value 0.03]), regardless of age or smoking. For hyperpigmentation, the best model included smoking ([OR8.47 (1.18-3.10), p = 1.31e-5), without race or type and/or time of treatment. In chapter 2, two categories emerged, the fear of informing the health professional about the diagnosis and the refusal of care by health professionals. Our results showed that oral manifestations were observed in PLHIV under treatment, predominantly periodontal disease with or without tooth mobility. The data indicate that there is a protective effect of treatment duration to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than to the type and duration of treatment. The results showed that there is a fear among patients to inform the dentist about their diagnosis, omitting it and that there was a perception of the presence of discriminatory attitudes by dentists, including refusal of care and excessive use of biosafety measures in PLHIV