July 20, 2016

UW, Kenya team on HIV oral health project

The University of Washington has joined forces with the University of Nairobi in an ambitious effort to combat the oral consequences of the human immunodeficiency virus (HIV) among Kenya’s children.

The Children’s Healthy Oral Management Project (CHOMP) is a collaboration involving the UW Department of Global Health, the UW School of Dentistry and the University of Nairobi. Kenya’s Ministry of Health and National AIDS/STI Control Programme are other partners.

Professor Arthur Kemoli

Professor Arthur Kemoli

CHOMP builds on a 25-year partnership between the UW and the University of Nairobi called the Kenyan Pediatric Studies, which seeks to improve health care in Kenya and the United States. Key support for CHOMP came via a grant from the UW’s Global Innovation Fund.

Along with mounting new prevention initiatives, CHOMP has begun training practitioners including pediatric dentists, community oral health officers and nurses to screen and treat children’s oral manifestations related to the human immunodeficiency virus. Over the long term, CHOMP’s leaders also hope to strengthen the UW-University of Nairobi research partnership and integrate oral exams into HIV treatment visits as dental staff are trained to diagnose and treat oral HIV-related oral diseases.

The project’s leaders include Dr. Ana Lucia Seminario of the UW’s Department of Pediatric Dentistry faculty; Professor  Arthur Musakulu Kemoli, Chair of the Department of Paediatric Dentistry and Orthodontics at the University of Nairobi; and Drs. Jennifer Slyker and Sarah Benki-Nugent of the UW Department of Global Health.

“I’m very excited,” said Dr. Seminario, who traveled to Kenya in January to review recent HIV research, help train oral health professionals, and refine CHOMP’s plans for 2016. “This is the first time they’ve included oral health in these discussions [of Kenya’s HIV challenges].”

Ana Lucia Seminario

Dr. Ana Lucia Seminario

“This problem is huge for Kenya,” which has an HIV infection rate of about 6 percent, Professor Kemoli said. “About 140,000 to 180,000 children in Kenya up to 1 year of age are believed to have HIV infection.” As many as 1.1 million children have been orphaned by the deaths of their parents from HIV, and 15 percent of deaths among children under 5 years of age are attributed to HIV, he said. The scope of the problem is similar or even greater in many other African countries, he added.

Oral candidiasis is one of the most common oral manifestations of HIV in children, producing a burning sensation in the mouth as well as nutrition problems and changes in taste. Other HIV-related pediatric oral diseases include herpes simplex, linear gingival erythema, and painful recurring ulcers.

“The disease is [also] associated with episodes of illness, fevers, diarrhea, and super-infections,” Professor Kemoli said. “These factors can result in oral effects involving both hard and soft tissues.” He also noted the impact of HIV on general health and on quality of life for the children, their families and their communities.

One hopeful trend is the dramatic improvement in HIV treatment over time, Dr. Seminario said. “Children aren’t dying from AIDS as they did in the early years when the disease appeared, so now it’s time to look at other aspects of the disease,” she said.

In particular, highly active anti-retroviral therapy (HAART), which was introduced in the mid-1990s, has helped reduce the rate of HIV-related oral symptoms. However, there are still many patients whose oral lesions persist after HAART, Dr. Seminario said, and even the drugs themselves can produce undesirable side effects.

“As dentists, we see oral defects that make us more aware of the consequences of medications,” she said, noting that the anti-retrovirals can affect infant oral health.

Kenya training clinic

In January, Dr. Ana Lucia Seminario trained clinical providers in Kenya.

“The use of drugs, like antibiotics, could have effects on the development of the dental tissues,” Professor Kemoli said. HIV-infected children have suffered developmental defects in tooth enamel linked to medications and/or disease, he said, also citing soft-tissue problems associated with the disease or the medications.

CHOMP’s leaders believe that even a modest number of newly trained practitioners can help make significant inroads. As few as 10 can screen and treat as many as 4,000 children a year, Dr. Kemoli said. Patients can be screened in a hospital, community clinic, school, or even at home, he said. To facilitate screening, CHOMP also wants to develop a salivary HIV test for children in lieu of drawing blood, Dr. Seminario said.

If additional resources can be found, CHOMP could expand its reach in and beyond Kenya, Professor Kemoli said, noting that he now chairs the Paediatric Dentistry Association of East Africa, which has members in Kenya, Uganda, Tanzania, Rwanda and Ethiopia.

Dr. Seminario also sees a potential for raising awareness of the issue here at home too, especially in focusing the conversations between health-care providers and pregnant women.

“I have HIV-positive patients, and the parents are very grateful when you discuss these issues with them,” she said.