Inflammatory Consequences of Intensive Periodontal Disease Treatment in HIV+ Adults

Objectives: Treatment of periodontal disease (PD) has been linked to alterations in markers of systemic inflammation (MSI). We hypothesized that treating PD in HIV+ adults would result in significant improvement in MSI.
Methods: HIV-infected adults with HIV-1 RNA <400 copies/mL on antiretroviral therapy (ART) for >1 year) received PD treatment (scaling and root planing) at baseline, 1 and 3 months. PD was measured clinically at baseline, 3 and 6 months as periodontal probing depths (PPD) and bleeding on probing (BOP), and microbiologically as level of Poryphromonas gingivalis (Pg), Campylobacter rectus (Cr), and Treponema denticola (Td) in subgingival plaque. MSI blood samples were collected prior to PD treatment at baseline, 1 day, 1 week, and at 1, 3 and 6 months. MSI were measured by ELISA and included high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and soluble CD14 (sCD14). Statistics included T-tests and mixed models with random intercept that controlled for baseline age, smoking status, time on ART, time on study and nadir CD4.
Results: Thirty (30) HIV+ adults completed the study. PPD and BOP decreased (p<0.001) as did microbial measures at 3 and 6 months (p≤0.028 for all except Td at 6 months). All three MSI increased at day 1 (p≤ 0.03). However at 6 months, only hsCRP decreased by 53.76% from baseline; (p=0.043), while IL-6 increased by 70.70%; (p=0.04); sCD14 did not change (p=0.58). Controlling for covariates, change over time in clinical and microbial measures of PD were unrelated to change over time in MSI; BOP approached significance in relation to soluble CD14 (p=0.08).
Conclusions: PD treatment resulted in an increase in all MSI measured at day 1. A direct longitudinal relationship between measures of PD improvement and changes in MSI at 3 and 6 months was not established in this HIV+ adult cohort; further exploratory analyses are ongoing.