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Dental problems go unresolved in many HIV patients

Oral infections, mouth ulcers, and other severe dental conditions associated with HIV infection go untreated more than twice as often as other health problems related to the disease, according to a new study supported by the Agency for Healthcare Research and Quality (HS08578). The study, which was conducted by researchers from the University of California, Los Angeles, and RAND, also found that uninsured people with HIV disease are three times more likely to have untreated dental and medical needs than those with private insurance. In addition, Medicaid enrollees who had State-sponsored dental coverage reported significantly more unmet dental needs compared with privately insured patients.

The study, which was based on interviews of HIV patients in a national probability sample in 1996, estimates that 58,000 of the approximately 231,000 people in treatment for HIV disease that year had either unmet dental or medical needs or both. Kevin C. Heslin, Ph.D., of UCLA's AIDS Research Training Center, led the research, which is the first to examine both unmet dental and medical needs in HIV patients.

The investigators estimated that 14.3 percent of HIV patients as a whole had unmet dental needs in the 6 months prior to being interviewed, about 6.2 percent had unmet medical needs, and 5 percent had both unmet dental and medical needs. By comparison, data from previous studies of the general population show that 9 percent had unmet dental needs, roughly 5.7 percent had unmet medical needs, and 2.5 percent had both unmet dental and medical needs. In addition, patients younger than age 50, the poor, the unemployed, and patients living in the South in general were more likely to report having unmet dental and medical needs than were people of mixed race and American Indians, Eskimos, Aleuts, Pacific Islanders, and Asians.

The researchers categorized patients as having unmet dental and medical needs if they reported needing but not receiving these services in the previous 6 months. Although problems with access may play a role, the study did not examine why needs went unmet or seek to identify specific needs. The study is part of the HIV Cost and Services Utilization Study (HCSUS), conducted by a consortium led by RAND Health under a cooperative agreement with AHRQ. Other Federal programs that support HCSUS include the National Institute of Dental and Craniofacial Research and the Health Resources and Services Administration.

Details are in "A comparison of unmet needs for dental and medical care among persons with HIV infection receiving care in the United States," by Dr. Heslin, William E. Cunningham, M.D., M.P.H., Marvin Marcus, D.D.S., M.P.H., and others, in the winter 2001 Journal of Public Health Dentistry 61, pp. 14-21.

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