CWRU DENTAL RESEARCHER HOPES TREATING GUM DISEASE REDUCES HEART DISEASE RISK IN HIV-INFECTED ADULTS
Heart disease is a leading killer of HIV-infected adults, and researchers are hoping to save lives by treating something entirely different—gum disease.
“Reducing heart disease for HIV patients has become a major public health priority,” says Lance Vernon, a senior instructor of biological sciences at Case Western Reserve University’s School of Dental Medicine.
One potential way to do that may be by treating gum disease. Vernon has a new two-year grant from the National Institute of Dental and Craniofacial Research to study 35 adults with HIV and gum disease.
Studies have found a link between oral health and heart health, and HIV-disease and possibly the antiviral medicines used to treat it -- called highly active antiretroviral therapy (HAART)--may accelerate atherosclerosis, a hardening of the arteries that restricts blood flow that can lead to heart attacks and strokes.
Heart disease has several biomarkers, such as inflammation and reduced elasticity in the artery walls. Bacteria from gum disease can enter the blood stream and set off inflammatory reactions, contributing to heart disease risk.
“By eliminating the bacteria which causes gum disease, we may help slow the progression of heart disease in HIV-infected adults,” Vernon says. Participants in the Case
Western Reserve study will be recruited from Cleveland area hospitals. Vernon will treat gum disease in research participants during the first three months of the study and follow them for a total of six months to see if there is a reduction in heart disease risk.
To qualify, adults with HIV must show that they have been stable on HAART for two years, have at least 20 teeth and have gum disease in at least 30 percent of their teeth. Their gum disease will be treated using nonsurgical methods, including scaling and root and applying topical antibiotics at the site of the gum disease.
Subjects will undergo medical tests before and after their treatment; ultrasound examinations will allow researchers to look at very sensitive changes that take place in the arm’s brachial artery blood flow. These early changes are strongly linked to the progression of heart disease.
The name of the ultrasound examination is flow mediated dilation, which tests the brachial artery’s diameter before and after blocking the blood flow above the elbow for five minutes with, essentially, a tightened blood pressure cuff.
“Healthier arteries will show a larger increase in diameter after the cuff is released,” said Vernon.
He added that it’s just like a rubber-band—more elasticity is better. “If treating gum disease lowers the risk for heart disease in HIV-infected adults, then we will want to identify gum disease earlier and treat it more aggressively in this population,” Vernon said.
Information from the study, “Immune and Inflammatory Consequences of Intensive Periodontal Disease treatment in HIV-infected Adults,” will contribute to the growing evidence of the role that oral health has in overall systemic health.