6th World Workshop on Oral Health and Diseases in AIDS
Beijing, April 21-24, 2009
Key-points for Research Agenda
The main goals of the workshop, supported in part by NIDCR, were 1) to bring together
clinician and laboratory scientists who have an interest in the oral manifestations of HIV
disease, to share worldwide perspectives, knowledge and understanding of oral health
and disease in HIV infection, and 2) to identify research needs taking account worldwide
perspectives and opportunities. The workshop was very successful and produced a new
agenda for oral HIV/AIDS research. The following key-points summarize the research
agenda developed as part of the 6th World Workshop on Oral Health and Diseases in
AIDS:
Role of HIV-related oral lesions as clinical markers of immunodeficiency in
changing era of new generation Antiretroviral therapy (ART)
Clinical studies should explore:
 Role of oral lesions in detecting ART failure and/or poor adherence to ART (in
particular in adolescents)
 Role of HIV-related oral lesions in context of the immune reconstitution
inflammatory syndrome (IRIS) and characterization of “oral-IRIS”
 Prevalence of oral lesions and their association with stage of HIV-disease and
HIV co-morbidities in particular in pediatric populations in resource-constrained
settings
 New therapies and new drug delivery systems for management of HIV-related
oral lesions (e.g., candidiasis; necrotizing diseases; warts) through well
designed clinical trials
New approaches to candida and mycotic infections
Pathogenesis studies should explore:
 Mechanisms of pathogenicity and virulence of Candida albicans in oral
candidiasis in HIV disease
 Mechanisms of antifungal resistance in the context of HAART failure
 Host pathogen interactions to develop immunotherapies and to understand role
of Candida in mucosal biofilms
 Characterization of the fungizome (fungal biofilm)
Clinical studies should explore:
 Role of candidiasis in predicting HAART failure, and emergence of antifungal
resistance in the context of HAART failure?
 Efficacy and acceptability of inexpensive alternative antifungal agents in
resource-constrained settings (e.g., gentian violet )
 Development of new topical slow release antifungal agents
 Preventative strategies against candidiasis in the infant
Co-infections and mechanisms of viral infections associated with HIV
Pathogenesis studies should explore:
 Mechanisms of viral interaction of oral opportunistic pathogens (e.g. EBV, CMV,
HSV, VZV, HPV and HHV-8)
 Mechanisms of enhanced HPV pathogenesis in HIV infected persons
 HPV-specific T-cell responses associated with oral HPV infection and disease
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Clinical studies should explore:
 Effect of new generation ART on oral HPV infection and disease (oral warts)?
 Risk of oropharyngeal squamous cell carcinoma among HIV-infected individuals
with oral HPV shedding (in particular HPV16)?
Role of innate and adaptive immunity of the oropharyngeal mucosa in HIV/AIDS
associated diseases
Pathogenesis studies should explore:
 Comparative structure and function of different mucosal tissues (oral vs. vaginal
vs. intestinal vs. colorectal; e.g., Functional genomics and proteomics)
 Interaction of HIV on oral microbiome, viriome, fungizome
 Induction of human neutralizing IgA antibodies against HIV in vivo
 Characterization of mucosal responses of “elite controllers” (highly exposed
persistently seronegative populations)
 Strategies to develop microbicides &/or vaccines to inhibit infection at mucosal
level
Mucosal fluids and biomarkers of clinical disease
Clinical studies should explore:
 Oral-based testing for HIV infection based on Ag/Ab (e.g., Sensitivity, specificity,
and predictive value of HIV RNA saliva assays as compared to plasma assays)
 Novel point of care devices (e.g., microfluidic device) and assays with higher
sensitivity and specificity (applicability and acceptability)
 The role of salivary diagnostics in oral complications of HIV infections (KSHV,
HPV, TB, HCV, cancer markers)
Social aspects of HIV, and relationship to oral/craniofacial problems
Clinical studies should explore:
 Use of patient centered outcomes (e.g., quality of life) in clinical trials
 Cumulative risk of tobacco, alcohol and recreational drugs in HIV infection and
impact on oral disease
 Impact of health promotion in resource -constrained setting
 Effectiveness of auxillaries and other partnerships in health care promotion in
resource constrained settings
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