Oral Microbiology Immunology 2003: 18: 199–201

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Short communication

Periodontal pathogens in M Patel1, M. Coogan1, J. S. Galpin2

1
Division of Oral Microbiology, Department
of Clinical Microbiology and Infectious
Diseases, Faculty of Health Sciences and
subgingival plaque of 2
School of Statistics and Actuarial Science,
Faculty of Science, University of The
Witwatersrand, Johannesburg, South Africa

HIV-positive subjects with

chronic periodontitis
Patel M, Coogan MM, Galpin JS. Periodontal pathogens in subgingival plaque
of HIV-positive subjects with chronic periodontitis.
Oral Microbiol Immunol 2003: 18: 199–201. ß Blackwell Munksgaard, 2003.

Many putative periodontal pathogens associated with periodontal disease in human

immunodeficiency virus (HIV)-infected patients also occur in non-HIV-infected
individuals. This study examined the prevalence of eight periodontal pathogens in
HIV-positive and HIV-negative patients with chronic periodontitis using the 16s RNA Key words: HIV; periodontal pathogens;
polymerase chain reaction technique. The results showed a significant prevalence of chronic periodontitis
Porphyromonas gingivalis and Treponema denticola among HIV-negative patients
compared to HIV-positive patients. Sixty percent of the patients in both groups were Dr M. Patel, Department of Clinical
Microbiology and Infectious Diseases,
colonized by five to six species. Odds ratio analysis revealed a statistically significant Faculty of Health Sciences, University of The
positive association between three of the 28 possible combinations in the HIV-positive Witwatersrand, Private Bag 3, Wits 2050,
group. They included Prevotella nigrescens/Campylobacter rectus, P. nigrescens/ South Africa
P. gingivalis and P. nigrescens/T. denticola. Although the prevalence of periodontal Tel: þ 27 11 717 2113;
fax: þ 27 11 717 2027; e-mail:
pathogens is similar in both the groups, the combination of certain periodontal patelms@dentistry.wits.ac.za
pathogens may be responsible for chronic periodontitis seen in HIV-infected adults. Accepted for publication November 25, 2002

The oral cavity is a primary site for colo- tissue necrosis or other features character- reported that P. gingivalis, P. intermedia,
nization by opportunistic pathogens. istic of HIV-infected patients (6). F. nucleatum and Treponema denticola
Patients infected with the human immu- A question that remains unanswered is were present more frequently and in larger
nodeficiency virus (HIV) often develop whether changes in patients with HIV in- numbers in HIV-infected than in HIV-ne-
oral lesions that are the first clinical ex- fection are specific to the infection or are a gative subjects (18) and another that there
pression of HIV infection (3, 15, 17). Even modified form of periodontal disease seen is higher prevalence of P. gingivalis in
though the relationship between periodon- in non-infected populations. Knowledge of HIV-negative than in HIV-positive subjects
tal health and HIV infection has been the microbiology associated with these (12). Several studies have shown there is a
extensively researched, most aspects of changes may help answer this question. similar microbial flora in both groups, and
the relationship remain poorly understood. Information on the microbiota associated no difference in the distribution of black
Periodontal diseases frequently associated with periodontitis in HIV-positive patients pigmented anaerobes (13, 14, 21). The pre-
with HIV infection include linear gingival is controversial. Several studies have sent study investigated the prevalence of
erythema, necrotizing ulcerative gingivitis shown that Porphyromonas gingivalis, eight periodontal pathogens in adult perio-
and periodontitis and chronic periodontitis Prevotella intermedia, Fusobacterium dontitis in HIV-positive patients using the
associated with increased attachment loss nucleatum, Actinobacillus actinomycetem- highly sensitive 16s RNA polymerase chain
(16). Similar lesions may occur in non- comitans, Eikenella corrodens and Cam- reaction (PCR) technique.
HIV-infected patients even at the same pylobacter rectus may occur in diseased Twenty HIV-positive patients at the
prevalence rates. HIV-infected individuals sites of HIV-positive patients and non- HIV Clinic, Johannesburg Hospital, and
may also suffer from chronic adult and HIV-infected subjects with classical peri- 20 HIV-negative patients attending The
rapidly progressive periodontitis without odontitis (4, 9, 10, 11, 22). One study Oral Medicine and Periodontology Clinic,
200 Patel et al.

Oral and Dental Teaching Hospital of the

Witwatersrand, Johannesburg, were inves-
tigated. All the patients had moderate
chronic periodontitis, pockets >4 mm with
a mean depth of 5 mm. The HIV-positive
group consisted of 10 males (mean age
41 years) and 10 females (mean age
34 years) with a mean CD4 count of 231
cells/mm3 (range 12–493). The control
group consisted of 12 males (mean age
42 years) and eight females (mean age
50 years). They were healthy subjects
who had no history of HIV-related ill-
nesses and did not belong to a high-risk
group. Written consent was obtained from
Fig. 1. Prevalence of subgingival microorganisms in HIV-positive and HIV-negative patients with
all patients prior to sample collection. chronic periodontitis.
Supragingival plaque was removed from
the gingival sulci of patients using a cotton
pellet. Subgingival plaque was collected
by inserting a paper point into the pocket, negative subjects is shown in Fig. 2. These disease because they were immunocom-
removing it after 30 s and placing it in data were analyzed using the Mann–Whit- promised and infected with the human
1 mL reduced transport fluid for transport ney test. The mean number of species in immunodeficiency virus and its compo-
to the laboratory. Two samples were ob- HIV-positive subjects was 4.25 and in nents.
tained from each subject and pooled for the HIV-negative subjects 5.25. There was The data were analyzed further to de-
analysis. The samples were vortexed and no significant difference between the num- termine whether a symbiotic relationship
washed in distilled water within 1 h of ber of species present in each group with existed between the species. An odds ratio
collection. The pellets were suspended in 60% of the patients in both groups being calculation was used to analyze the rela-
10 mL 10XPCR buffer and 90 mL sterile colonized by five to six species. However, tionship between any two bacterial species
distilled water, boiled for 4 min and placed three or more species were detected in the in each group. The significance of the
on ice. After centrifugation, the superna- pockets of all the HIV-negative and in 14 association was determined by the Fisher
tant was collected for qualitative PCR of the HIV-positive patients. This suggests Exact test. Where one of the microorgan-
analysis. The PCR technique was set up the combined activities of these pathogens isms was always present, the binomial test
using P. gingivalis W4087, a clinical iso- contributed to the destruction of the peri- was used. Nine combinations were signifi-
late from Guy’s Hospital, London, P. in- odontal tissues in these subjects. The 14 cant in the HIV-negative group, C. rectus
termedia ATCC 25611, P. nigrescens HIV-positive patients probably developed occurred with P. gingivalis, E. corrodens,
ATCC 25261, F. nucleatum ATCC the condition before they were infected F. nucleatum, T. denticola and A. actino-
25586, E. corrodens NCTC 10596, C. rec- with HIV. The six remaining HIV-positive mycetemcomitans and T. denticola with
tus NCTC 11489 and A. actinomycetemco- patients differed from this group because P. gingivalis, E. corrodens, F. nucleatum
mitans ATCC 43718. The primers and they carried fewer periodontal pathogens. and A. actinomycetemcomitans. Computa-
PCR technique described by Ashimoto One patient carried C. rectus and E. corro- tion of odds ratios indicated a positive
et al. (1) was used for P. gingivalis, P. in- dens, another T. denticola and F. nuclea- association for five of the 28 bacterial pairs
termedia, P. nigrescens, E. corrodens, tum, three carried only C. rectus, within the HIV-positive group (P < 0.05).
C. rectus, A. actinomycetemcomitans and E. corrodens or P. nigrescens, and no per- Three of these combinations, P. nig-
T. denticola and the primer (5059S) and iodontal pathogens could be detected in the rescens/C. rectus (13.5), P. nigrescens/P.
technique described by Avila-Campos sixth patient. These patients probably de- gingivalis (39.3) and P. nigrescens/T. den-
et al. (2) for F. nucleatum. veloped a modified form of periodontal ticola (16.2), were found exclusively in the
The detection rate of periodontal patho-
gens in the HIV-positive and negative
subjects is shown in Fig. 1. Fisher’s exact
test was used to compare the prevalence
between the two groups. T. denticola (P ¼
0.02) and P. gingivalis (P ¼ 0.06) were
significantly more prevalent in HIV-nega-
tive than in HIV-positive subjects. Similar
results were found by Murray et al. (12).
There was no particular distribution of A.
actinomycetemcomitans, which was iso-
lated from two HIV-infected and three
HIV-negative subjects. This species was
not restricted to young people but was also
found in subjects whose ages ranged from
28 to 52 years. The number of species Fig. 2. Number of species detected in HIV-positive and HIV-negative patients with chronic
that occurred in HIV-positive and HIV- periodontitis.
 Periodontal pathogens in HIVþ subjects 201

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periodontal pathogens in HIV-associated
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