Since the AIDS epidemic reared its head in the 1980s, the nature of this disease has quickly evolved from a devastatingly debilitating disease to one of chronicity. These patients are requesting for and are entitled to the optimal restorative treatment plans, many of which include dental endosteal implants. Several authors have delved into the realm of implantology in the HIV-positive patient, but there is only one study specifically for the AIDS patient (CD4 count <200 cells/μL), though patients were followed up for 6 months only . The two criteria generally used to ascertain the immunological status and disease progression of the HIV-positive patient are (1) viral load and (2) CD4 count. Viral load although controversial in its ability to quantify disease progression is stratified as high (5000–10,000 copies/mL), low (200–500 copies/mL), and as a treatment goal to be less than 50 copies/mL. The CD4 count has become the mainstay to our infectious disease colleagues to tailor the medicinal regiment of the HIV-positive and AIDS patient. The prophylactic medications administered are based upon the particular range of the CD4 count. This value is used as a window to predict the type of organisms the patient is susceptible to. We stratified our study population by these means in an effort to note any such trends.
As the HIV-positive patient reaches the low end of CD4 spectrum and manifests AIDS, this puts the patient in a further immunocompromised state, opening the doors to a multitude of opportunistic infections and neoplasia. One may erroneously hesitate to offer this patient the full scope of dental restorative options because of lack of awareness. Intuitively, one may expect this person to be more prone to infection, possessing a poorer quality of bone and compromised healing from surgery. These concerns may lead the dental surgeon to favor non-surgical restorations, prophylactic antibiotics, and a lower expectation of success if implants are to be placed.
Generally speaking, the use of antibiotics in dental implantology has been controversial. Amongst the reasons for early (preloading) implant failure are bacterial contamination, systemic disease, chemotherapy, overheating of bone, poor recipient site bone quality, and poor bone to implant contact upon surgery. After the prosthetic phase of the implant restoration, loading forces exceeding the bone to implant interface is an additional cause of early failure. Prophylactic antibiotics are shown to reduce dental implant failure but do not have much influence on post-operative infections . The organisms most responsible for infections associated with the failing implant in a “healthy” patient are predominantly Gram-negative anaerobic rods .
Anecdotally, many practitioners have decided to administer prophylactic antibiotics to all of their patients receiving endosteal implants while others have taken a more conservative approach. A survey of 102 periodontists revealed that >50 % prescribe antibiotics in 10 specific periodontal or implant-related clinical circumstances . A metaanalysis of patients HIV positive and with AIDS revealed no evidence of increased risk of complications associated with dental procedures .
HIV causes systemic infection with diverse multi-organ system manifestation, musculoskeletal symptoms often being the first clinical indication of the presence of disease. Habermann et al. in a study of 41 patients noted an increased infection rate of 12.7 % in HIV-positive hemophiliacs and non-hemophiliacs undergoing total joint arthroplasty. They also reported that there was no difference in functional outcomes in non-hemophilic HIV-positive and HIV-negative population after the surgery . Supporting the above findings, a retrospective analysis of patients from 2003 to 2010 showed that none with CD4 indicative of AIDS at the time of total joint replacement developed implant infection .
In HIV-infected patients, CD4 count and albumin levels negatively correlate with incidence of post-operative sepsis, whereas surgical infections and previous major surgical procedures positively correlated with the incidence of post-operative sepsis . Thirty-five HIV-infected patients undergoing abdominal operations with pre-operative CD4 <200 or CD4/CD8 ratio <0.15 had overall higher post-operative sepsis morbidity .
Regarding dental procedures, a retrospective cross-sectional study of 101 HIV patients was done from 2003 to 2005. Complication rate was found to be 2.2 % overall and 4.8 % after invasive dental procedures. No relationship was found between complications and immunological values . Another study examining healing response after surgical crown lengthening in 21 patients with HIV was analyzed, and none had post-operative complications like delayed healing, infection, or prolonged bleeding .
In summary, our study indicated that dental endosteal implants placed in a population of AIDS patients under good surgical and prosthetic planning and surgical technique have no significant difference in failure rate than those placed in healthy patients. Therefore, this restoration should be made available to HIV-seropositive patients, including those patients meeting the criteria for an AIDS diagnosis. The success of the implants appears to be independent of CD4 count.