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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 7  |  Issue : 3  |  Page : 135-139

Undiagnosed human immunodeficiency virus-positive patients in a dental health-care setting in Benin City, Nigeria


1 Department of Oral Diagnosis and Radiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria

Date of Web Publication22-Aug-2016

Correspondence Address:
Clement Chinedu Azodo
Department of Periodontics, Prof. Ejide Dental Complex, Room 21, 2nd Floor, University of Benin Teaching Hospital, P.M.B. 1111 Ugbowo, Benin City, Edo State
Nigeria
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DOI: 10.4103/0976-433X.188800

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  Abstract 

Background: Barrier to client-initiated voluntary counselling and test. (VCT) which exists in many places in Nigeria creates additional opportunity for provider.initiated VCT. Aim: To determine the prevalence of undiagnosed human immunodeficiency virus (HIV) infection among dental patients in a missionary hospital in Benin City, Edo State, Nigeria. Materials and Methods: This retrospective study was conducted in a Pentecostal missionary hospital in Benin City. The data of interest which included age, gender, occupation, primary reason for dental attendance, primary diagnosis, and HIV status were collected from the case notes with self-designed pro forma. The obtained data were analyzed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY). Results: Out of the 613 cases assessed, 7 of them were HIV-positive giving a prevalence of 1.14%. The HIV-positive patients were aged between 11 and 50 years. More females (1.5%) than males (0.7%) were HIV-positive. HIV-positive patients were involved in diverse occupations ranging from schooling, business, and clergy to professionals. The patients whose primary reason for dental attendance was toothache had the highest prevalence of HIV and those with primary diagnosis as periodontitis had the highest prevalence of HIV. Conclusion: Data from this study revealed the one out of approximately every 88 patients attending the Dental healthcare setting Clinics in Benin City, Edo State, had undiagnosed HIV.positive status. The affected patients who were more females than male and aged between 11 and 50. years had their major presenting complaints and diagnosis as toothache and periodontitis, respectively. Dental health.care setting may serve as a provider.initiated VCT center for ambulatory patients.

Keywords: Dentistry, human immunodeficiency virus, voluntary counselling and test


How to cite this article:
Ogbebor O G, Azodo CC. Undiagnosed human immunodeficiency virus-positive patients in a dental health-care setting in Benin City, Nigeria. SRM J Res Dent Sci 2016;7:135-9

How to cite this URL:
Ogbebor O G, Azodo CC. Undiagnosed human immunodeficiency virus-positive patients in a dental health-care setting in Benin City, Nigeria. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Jan 15];7:135-9. Available from: https://www.srmjrds.in/text.asp?2016/7/3/135/188800


  Introduction Top


The human immunodeficiency virus (HIV) infection constitutes the greatest health challenge of our time. It is one of the most deadly diseases in the 20th and 21st centuries thereby constituting a great threat to the human race. In all of this, no cure has been found, but all efforts are geared toward the prevention and control of this dreaded disease.

The early enrollment for antiretroviral therapy offers immense benefits to the affected individuals, their family, and community as a whole. These benefits include improved overall quality of life, productivity, and survival rate of the HIV-infected individual and also a decrease in the possibility of transmission to sexual partners, offsprings, and others.[1],[2],[3],[4],[5],[6] The cycle of care for HIV-infected individual usually begins with HIV testing and diagnosis of HIV infection. However, the knowledge of HIV status through client-initiated voluntary counselling and test (VCT) which is easily accessible in Nigeria precedes enrollment into holistic HIV care.

VCT usually involves two counselling sessions: One before taking the test known as pretest counselling and one following the HIV test when the results are given, often referred to as posttest counselling. Counselling focuses on the infection (HIV), the disease (AIDS), the test, and positive behavior change. VCT has been cited as a gateway to various HIV preventive care and support services including prevention of mother to child transmission and anti retroviral therapy commencement. VCT provides an opportunity for people to learn about HIV/AIDS and make them aware, accept, and cope with their serostatus.[6] It stands out as a critical entry point to the full spectrum of life-sustaining care and treatment for people living with HIV.[6] It also provides psychological support to the people living with HIV/AIDS and people affected by AIDS and facilitates behavioral change and thus reducing stigma and discrimination in the communities. However, this VCT is impeded by numerous barriers ranging from ignorance, erroneous belief, and fear of being stigmatized to misconceptions.[7],[8],[9] In a study among youths in Benin City about a decade ago, more than half (58%) of them did not agree to routine HIV screening, and their reasons included psychological trauma, infringement on fundamental human rights, fear of living with positive screening, stigmatization, and victimization at the place of work if positive.[10]

Although the first case of AIDS was reported in 1986 in a 13 year old sexual active female street hawker, it has attained epidemic proportion and contributes highly to the global prevalence of HIV infection. The National Sentinel Survey that started in 1991 showed the following prevalence 1.8% (1991), 3.8% (1993), 4.5% (1996), 5.4% (1999), 5.8% (2001), 5.0% (2003), 4.4% (2005), 4.6% (2008), and 4.1% (2010).[11] Edo State as one of the six states that make the South-South geopolitical zone and one of the 36 states and that make up Nigeria is burdened by the HIV prevalence that is above the national average implying that diagnosed and undiagnosed HIV-infected individuals are receiving dental and medical health-care services in this state.[11] Based on the low level of uptake of client-initiated VCT, it is safe to state that the majority of HIV-infected individuals are likely to be undiagnosed status and that provider-initiated VCT will offer an opportunity for those who have not benefited from the client-initiated VCT.

Several studies to determine the prevalence of HIV among patients in almost all sector of health-care delivery have been conducted, but such studies among dental patients are few despite the fact that transmission of HIV may occur in the dental health care through puncture wound, the use of unsterilized needles, surgical implements, infected blood, and blood products.[12],[13],[14],[15],[16],[17],[18],[19] In Nigeria, studies on the prevalence of HIV among dental patients have been conducted in only in two out of six geopolitical zones in Nigeria, namely Southwest [18] and Southeast.[19] In all the previous studies, patients recruited were either few in numbers or the surveys were restricted to patients receiving a particular procedure or conducted in government hospitals.[11] Hence, this study was undertaken to compensate for the lack of coverage since none of these studies were conducted in the South-South geopolitical zone and nongovernment-owned hospital bearing in mind, the geographical variations in the prevalence of HIV infection within Nigeria. The aim of the study was to determine the prevalence of undiagnosed HIV infection among dental patients in a Pentecostal missionary hospital in Benin City, Nigeria.


  Materials and Methods Top


This 14 months retrospective study (from May 2009 to July 2010) was conducted after obtaining ethical approval from the Ethics and Research Committee of the Pentecostal missionary hospital in Benin City, Nigeria. Benin City, which is the capital of Edo State and one of the oldest cities in the South-South geopolitical zone of Nigeria. The policy of hospital is that all dental patients must undergo provider-initiated VCT. This is usually conducted/completed before their contact with the attending dentists.

The data of interest which included age, gender, occupation, primary reason for dental attendance, primary diagnosis, and HIV status were collected from the case notes with self-designed pro forma. Cases with incomplete data were excluded from this study. The prevalence of HIV in the studied hospital was assessed with Determine kit on capillary blood obtained from finger prick. If the result is positive, confirmation is done with STAT PAC. In case where the test is positive with Determine kit but negative with STAT PAC then UniGold is used to ascertain the true result as it is known to break the tie. The obtained data were analyzed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY). Test for significance was done using Chi-square and Fisher's exact statistics. Statistical significance was set at P < 0.05.


  Results Top


A total of 630 cases were retrieved, but 17 cases were excluded, leaving 613 cases for the final analyses [Figure 1]. Out of the 613 cases assessed, 7 of them were HIV-positive giving a prevalence of 1.14%. The HIV-positive patients were aged between 11 and 50 years. Females (1.5%) more than males (0.7%) were HIV-positive. This was not statistically significant (P = 0.462). HIV-positive patients were of diverse occupation which ranged from schooling, business, and clergy to professionals [Table 1]. The patients with their primary reason for dental attendance was toothache had the highest prevalence of HIV and those with primary diagnosis as periodontitis had the highest prevalence of HIV. There was no statistically significant relationship between HIV status, primary reason for dental attendance (P = 0.678), and diagnosis among the patients (P = 0.729) [Table 2].
Figure 1: Case selection flow diagram

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Table 1: Demographic characteristics among human immunodeficiency virus-positive and human immunodeficiency virus-negative patients

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Table 2: Primary reason for dental attendance and diagnosis among human immunodeficiency virus-positive and human immunodeficiency virus-negative patients

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  Discussion Top


HIV screening in dental health-care settings will foster the early detection of HIV infection, help health-care workers identify and counsel persons with previously unrecognized HIV infection and link them to clinical and prevention services, and further reduce the transmission of HIV. This study was a retrospective study of dental patients of Pentecostal missionary hospital in South-South geopolitical zone of Nigeria, which has an established provider-initiated VCT protocol. In this study, the prevalence of HIV was higher than 0.2% reported among patients undergoing ophthalmic surgery in Kaduna State of Nigeria.[20] However, it is lower than reported values among Nigerian dental patients in Ibadan (2.3%)[18] and Enugu (4.0%),[19] emergency departments patients (5.8%)[14] in Lagos, patients with head and neck malignancies (1.9%) in Ibadan,[21] and ophthalmic surgical patients in Edo (2.6%),[22] Enugu (3.0%),[23] and Ebonyi (3.7%)[24] States of Nigeria. Internationally, it was also lower than 4.8% reported among patients attending oral and maxillofacial surgery outpatient clinic in an urban hospital.[17] This could be explained by the geographical difference in the prevalence of HIV infection.[11] Although the prevalence of undiagnosed HIV in the study appeared low, the introduction of provider-initiated VCT in Nigerian nonpublic owned dental health-care setting is justifiable as it helps in offering the testing opportunity to the untested individuals, and early awareness of HIV status that will encourage anti retroviral treatment enrollment to improve survival and prevent transmission to others.

Patients in the fifth decade of life had the highest prevalence of HIV in this study which agreed with findings of the study conducted by Ukponmwan et al.[22] in Benin City but contrasted with findings of prevalent HIV infection in the second and third decade by Esan et al.[14] in Lagos State among emergency department patient and Okoye et al.[24] in Ebonyi State among ophthalmic surgical patients and Arobita et al.[18] in Oyo State among Oral surgery patients who reported dominantly infected with HIV-infection. The variation of prevalence and pattern of HIV across the States that make up Nigeria may be the explanation for this finding.

In this study, the females had a higher prevalence of HIV (1.5%) which is more than double that reported in the males (0.7%). This was similar with female preponderance reported Ukponmwan et al.[22] among ophthalmic surgical patients and Amadi et al.[19] among dental patients but differed with the pattern noted in previous studies where more HIV-positivity were recorded in male than females.[18],[24] The higher prevalence of females than males as dental clinic attendees may be an explanation for this HIV prevalence seen in this study as HIV prevalence in Nigerian general public is higher in females than males.[11]

There was diversity in the occupations of HIV-positive patients in this study reflecting the affection of almost all strata of population by HIV and also highlights the burden implication of HIV on family, schooling, and the community as a whole. The attraction of clergy to receive care in missionary hospital may explain why the clergy had a high prevalence of HIV.

Patients with toothache as their primary reason for dental attendance had the highest prevalence HIV-positive patients followed by those that complained of deposits. This means that the presenting complaints of undiagnosed HIV-positive patients do not classically differ from the other patients as toothache was the main reason for dental attendance. Patients with diagnosis of periodontitis and gingivitis had more HIV than those with diagnosis of dental caries. This attests to the classification of periodontal disease as lesions strongly associated with HIV infection by the EC-Clearinghouse on Oral Problems Related to HIV Infection and WHO Collaborating Centre on Oral Manifestations of the HIV.[25] Dentists and other dental health-care workers in Nigeria should therefore employ optimal infection control practices when attending to patients with common dental presenting complaints and diagnosis as they may be undiagnosed HIV-positive patients. This study finding should be interpreted with care because it is limited by missing cases such as other retrospective studies.


  Conclusion Top


Data from this study revealed the one out of approximately every 88 patients attending the Dental healthcare setting Clinics in Benin City, Edo State, had undiagnosed HIV-positive status. The affected patients who were more females than male and aged between 11 and 50 years had majorly periodontal presenting complaints. Dental health-care setting may serve as a provider-initiated VCT center for ambulatory patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

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    Tables

  [Table 1], [Table 2]


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[Pubmed] | [DOI]



 

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