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People who have HIV can suffer from up to 16 oral conditions that can cause pain and worry or affect their appearance and functioning (for example, ability to speak, eat, or swallow). Side effects of HIV medications such as dry mouth, sore throat, and loss of appetite may compound the problem. Yet most measures of health-related quality of life (HRQOL) and stage of disease for people with HIV do not include indicators of oral functioning and well-being. Oral health is strongly associated with physical and mental health among HIV-positive patients and should be considered when assessing HRQOL, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08578).
Researchers from the University of California, Los Angeles, RAND, and the Doris Duke Foundation used data from the HIV Cost and Services Utilization Study (HCSUS)—a national probability sample of adults with HIV—to assess physical and mental HRQOL (measured on a 0-100 range). They also used seven indicators of specifically oral-related HRQOL: pain and discomfort, worry, appearance, and function. The number of oral symptoms was strongly associated with a decrease in oral HRQOL. A one point increase in oral HRQOL was associated with a 0.10 increase in mental HRQOL and 0.07 increase in physical HRQOL.
In multivariate analyses, higher oral HRQOL was related to oral symptoms, general physical functioning, HIV-related symptoms, and emotional well-being. HIV exposure via intravenous drug use was related to lower oral HRQOL compared with exposure via male-to-male sex. Age younger than 35, HIV exposure via male-to-male sex versus heterosexual activities, being male, and prior measures of physical functioning and emotional well-being were associated with better physical HRQOL. HIV-related symptoms and oral symptoms were associated with worse physical HRQOL. Finally, HIV exposure via sex rather than intravenous drug use, black race, private insurance versus Medicaid, and oral HRQOL were associated with better mental HRQOL, as were low levels of oral symptoms and HIV-related symptoms.
For more information, see "Associations of self-reported oral health with physical and mental health in a nationally representative sample of HIV persons receiving medical care," by Ian D. Coulter, Ph.D., Kevin C. Heslin, Marvin Marcus, D.D.S., M.P.H., and others, in Quality of Life Research 11, pp. 57-70, 2002.
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