Oral
health care is an important component
of the management of patients with HIV
infection. A poorly functioning dentition
can adversely affect the quality of life,
complicate the management of medical conditions,
and create or exacerbate nutritional and
psychosocial problems.5 When the oral
cavity is compromised by the presence
of pain or discomfort, maintaining adherence
to complicated antiretroviral therapy
regimens becomes more difficult.6
There is limited evidence on the risks
of oral procedures among persons with
HIV/AIDS. Evidence for the utility of
selected oral lesions as markers for seroconversion
is limited to a single study of a single
oral condition—candidiasis.7 In
the later stages of HIV disease, greater
numbers of oral lesions and aggressive
periodontal breakdown are more likely;
therefore, oral health care visits should
be scheduled more frequently.8
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| Health-care
providers considering the use of antiretroviral
agents for HIV-1 infected women during
pregnancy must take into account two separate
but related issues:
- Antiretroviral treatment of maternal
HIV-1 infection, and
- Antiretroviral chemoprophylaxis to
reduce the risk for perinatal HIV-1
transmission
The benefits of antiretroviral therapy
for a pregnant woman must be weighed against
the risk of adverse events to the woman,
fetus, and newborn. Although ZDV chemoprophylaxis
alone has substantially reduced the risk
for perinatal transmission, antiretroviral
monotherapy is now considered suboptimal
for treatment of HIV-1 infection, and
combination drug regimens are considered
the standard of care for therapy. Initial
evaluation of an infected pregnant woman
should include an assessment of HIV-1
disease status and recommendations regarding
antiretroviral treatment or alteration
of her current antiretroviral regimen.
This assessment should include the following:
- Evaluation of the degree of existing
immunodeficiency determined by CD4+
count,
- Risk for disease progression as determined
by the level of plasma RNA, History
of prior or current antiretroviral therapy,
- Gestational age, and
- Supportive care needs.
Decisions regarding initiation of therapy
should be the same for women who are not
currently receiving antiretroviral therapy
and for women who are not pregnant, with
the additional consideration of the potential
impact of such therapy on the fetus and
infant.
Further, use of ZDV alone should not
be denied to a woman who wishes to minimize
exposure of the fetus to other antiretroviral
drugs and therefore, after counseling,
chooses to receive only ZDV during pregnancy
to reduce the risk for perinatal transmission.[1]
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