Ten Year Longitudinal Analyses/Risk for Dental Caries in HIV Seropositive Women

描述(申请人提供)：众所周知，龋齿(龋齿)是美国最常见的疾病之一，往往不成比例地影响种族和少数族裔，以及那些在经济和社会上处于不利地位的人，以及有潜在医疗问题的人。艾滋病毒携带者可能是少数族裔/种族，与艾滋病毒携带者相比，他们可能在社会经济上处于不利地位。最近一项为期5年的调查发现，艾滋病毒感染与龋齿有关，但造成这种差异的原因尚不清楚，也许最重要的是，由于这项研究，艾滋病毒+人群中的龋病危险因素没有得到很好的界定。这项拟议的调查的目的是澄清艾滋病毒感染和龋齿之间的关系。妇女机构间艾滋病毒研究(WIHS)及其口述分研究(WIHS-OS)是美国最大的艾滋病毒携带者研究队列之一，提供了从1995年开始到最近(2004年11月)对艾滋病毒携带者进行较长时间跟踪的最大规模的艾滋病毒携带者医疗、访谈和牙科数据。作为WIHS-OS的一部分，1995-96年从母方WIHS核心招募了844名妇女(719名艾滋病毒阳性，125名艾滋病毒-)，主要是少数族裔；2001/02年，为了调查艾滋病毒药物对各种结果的影响，又增加了173名艾滋病毒+妇女，共计1017名妇女。参与者每六个月进行一次面试、体检和牙科检查。我们建议使用标准和适当的统计方法，使用WIHS和WIHS-OS，检查人口因素(收入、教育、种族/民族、药物使用)、行为因素(吸烟、非法药物使用、使用牙科服务和口腔自我护理)、艾滋病毒疾病严重程度、艾滋病毒药物使用和口腔健康因素(唾液、口腔卫生和牙周病)是否与龋病在十年内的发展有关。这些拟议的分析与以前进行的分析不同，因为它们将包括在整个10年观察期内从WIHS-OS中的所有妇女收集的数据，还因为它们将包括对这一组以前没有检查过的因素的分析。考虑到数据库的规模、龋齿随访的长期性和前瞻性以及数据的高质量，这些分析提供了解决目前尚未回答的有关艾滋病毒阳性者龋齿性质的问题的最佳机会。这些分析的结果将为牙科和医疗提供者以及那些对照顾艾滋病毒感染者的医疗、牙科和社会福利负有责任的个人和机构提供急需的临床、实用和公共卫生信息。最近的研究发现，由于药物的副作用以及HIV+者的健康损害和促进健康的行为，HIV感染可能使人更容易发生龋齿。这项拟议的研究是相关的，因为它将解决目前尚未回答的有关艾滋病毒阳性者龋齿性质的问题。这些分析的结果将为牙科和医疗提供者以及那些对照顾艾滋病毒感染者的医疗、牙科和社会福利负有责任的个人和机构提供急需的临床、实用和公共卫生信息。

DESCRIPTION (provided by applicant): It is well-established that dental caries (dental decay), one the most prevalent diseases in the United States, tends to disproportionably affect racial and ethnic minorities, and those who are economically and socially disadvantaged, and those with underlying medical problems. HIV+ persons are likely to be ethnic/racial minorities and are likely to be socio-economically disadvantaged, compared to HIV- persons. A recent 5-year investigation found that HIV infection was related to dental caries, but reasons for the disparity were unclear, and, perhaps most importantly, risk factors for caries within the HIV+ persons were not well defined as a result of this study. The objective of this proposed investigation is to clarify the relationship between HIV infection and dental caries. The Women's Interagency HIV Study (WIHS) and its oral sub-study (WIHS-OS) represent one of the largest studied cohorts of HIV+ persons in the United States, and provide the largest collection medical, interview and dental data of HIV+ persons followed for an extended period of time, beginning in 1995 and ending only recently (November, 2004). As part of the WIHS-OS, 844, primarily minority, women (719 HIV+, 125 HIV-) were recruited from the parent WIHS core in 1995-96; in 2001/02, in order to investigate the effects of HIV medications on a variety of outcomes, an additional 173 HIV+ women were added, for a total of 1017 women. Participants had interviews, medical and dental exams every six months. We propose to examine, using standard and appropriate statistical methodologies, using the WIHS and the WIHS-OS, whether demographic factors (income, education, race/ethnicity, drug use), behavioral factors (smoking, illicit drug use, use of dental services and oral self-care), HIV disease severity, HIV medication use, and oral health factors (saliva, oral hygiene and gum disease) are related to the development of caries over ten years. These proposed analyses are different from analyses that have been previously done because they will include data collected over the entire 10-year period of observation, from all women in the WIHS-OS and because they will include analysis of factors that have not previously been examined in this group. These analyses provide the best opportunity to resolve currently unanswered questions regarding the nature of caries in HIV+ persons, given the size of the database, the long, prospective nature of the follow-up for dental caries, and the high quality of the data. The results of these analyses will provide greatly needed clinical, practical, and public health information to dental and medical providers, as well as to those persons and agencies that are indebted to caring for the medical, dental and social welfare of persons with HIV infection. Recent studies have found that HIV infection may predispose persons to the development of dental decay (caries) due to side effects from medications and because of health damaging and health promoting behaviors in HIV+ persons. This proposed study is relevant because will resolve currently unanswered questions regarding the nature of caries in HIV+ persons. The results of these analyses will provide greatly needed clinical, practical, and public health information to dental and medical providers, as well as to those persons and agencies that are indebted to caring for the medical, dental and social welfare of persons with HIV infection.