New trends in HIV-1 infection and Periodontitis research: microbial translocation, systemic inflammation and viral reservoirs

Abstract

Despite advances in AIDS control after the advent of combination antiretroviral therapy (cART), immune activation persists and is associated with disease progression caused by the human immunodeficiency virus (HIV)-1. HIV-1 infection has been associated with periodontitis, and it is known that periodontitis influences the systemic state and may be responsible for the continuous immune stimulation in HIV-1 infection. Furthermore, the complete eradication of HIV-1 is not yet possible, mainly due to its ability to integrate into the genome of immune cells and epithelial cells, which act as efficient reservoirs. We recently showed that gingival tissue may be a potential reservoir for HIV-1; however, these results need validation. Using a non-randomized clinical trial, we aim to answer two main questions: In the cART era, does periodontitis and periodontal treatment affect the levels of systemic inflammatory markers in HIV-infected individuals? and Can gingival tissue be a significant reservoir of HIV-1? Sixty HIV-infected patients, 30 with periodontitis and 30 without periodontitis, will be included in the study. Ten volunteers without HIV-1 and periodontitis will be the control for answering the question #1. All HIV-infected patients must be cART responsive, and on the same cART protocol, and those with periodontitis will receive non-surgical periodontal therapy (NSPT). Periodontal clinical parameters, subgingival microbiota, serum lipopolysaccharide and soluble CD14 in urine and plasma, macrophage migration inhibitory factor and intestinal fatty acid binding protein will be determined before and 30 days after NSPT. Additionally, we will investigate the number of HIV DNA and RNA copies by real-time PCR in gingival tissue and saliva comparing them with the numbers found in the blood. Finally, the cellular composition of the gingiva and the interactions of ±4²7 integrin will be analyzed through amplification and sequencing of the viral glycoprotein gp120. This study was approved by the Research Ethics Committee of the Faculty of Dentistry of Ribeirão Preto (CAAE: 50004415.1.0000.5419), and all participants must provide free and informed consent. (AU)