AIDS'te periodontal bulgular ve periodontal hastalık patogenezi

Özet

Kazanılmış bağişıklık yetersizligi sendromu (AIDS), RNA retrovirusler grubundan insan bagisiklık yetersizligi virusu (HIV) nun infeksiyonu sonucunda ortaya cikmaktadir. Gunumuze kadar yaklasik 36 milyon insan HIV virusunün bilinen 10 alt turü tarafından infekte edilmis ve sonucta da 20 milyon kisi bu nedenle hayatini kaybetmistir. HIV infekte bireylerde gorülen temel periodontal bulgular; linear gingival eritem, nekrotizan ulseratif gingivitis, nekrotizan ulseratif periodontitis, ve nekrotizan ulseratif stomatitistir. HIV virusunün immun sistem hücrelerine ve ozellikle de CD4 yardimci T lenfositlerine karsi guclü bir affinitesi vardir. Ek olarak monositler, makrofajlar, Langerhans hucreleri, noronal ve glial beyin hucreleri de infekte edilebilmektedir. infekte T hucrelerinde gorulen fonksiyon degisikligi, sekonder olarak B hucre disregulasyonuna ve degismis notrofil fonksiyonuna neden olmaktadir. Bu nedenle, HIV infekte bireyler malign hucre gelisimi, ve periodonto-patojenik mikroorganizmalar, virusler ve Kandida turleri ile iliskili infeksiyonlar icin artmis risk altindadirlar. Periodontal hastaliga sahip HIV infekte bireylerin mikrobiyal florasi uzerinde yapilan son caışmalarda doku nekrozuyla iliskili oportunistik bakteriyal, fungal ve viral turlerin sayilarınin arttigi bildirilmistir. HIV a ilaveten diger virusler ve mikroorganizmaların sayilarındaki artiş konak cavabmm koruyucu kolunu inhibe ederken, konak cevabmin yikici kolunu stimule etmektedir. Sonuç olarak interlokin-1 (3 (IL-1 P), interlökin-6 (IL-6), tumor nekroz faktor cc (TNF- cc) ve matriks metalloproteinazlar (MMPs) gibi doku yikimindan sorumlu inflamatuvar medaitorlerin sekresyonunda artis olmaktadir. Bu derleme makalesinde HIV infekte bireylerde gorulen periodontal bulgular ve periodontal hastalık patogenezi incelenmistir.

Abstract

Acquired immunodeficiency syndrome (AIDS) is due to an RNA retrovirus known as the human immunodeficiency virus (HIV). Approximately 36 million individuals have been infected with one of the 10 known subtypes of HIV, resulting in 20 million people deaths. AIDS can have a variety of oral and periodontal manifestations. The main periodontal manifestations in HIV infected patients are linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis and necrotizing ulcerative stomatitis. HIV has a strongly affinity for cells of immune system and most specifically affected cells are CD4 helper T lymphocytes. In addition, monocytes, macrophages, Langerhans cells and neuronal and glial brain cells may also be affected. Altered function of Infected T lymphocytes secondarily causes the B-cell dysregulation and altered neutrophil function. For that reasons, HIV infected individuals at increased risk for malignancy and periodontal infections relation with periodontopathic microorganisms, viruses, and Candida species. Recent studies on the microbial flora of periodontal lesions in HIV patients with periodontal disease confirmed the elevated levels of opportunistic bacterial, fungal and viral species associated with tissue necrosis. The presence of elevated levels of HIV, other viruses and microorganisms may lead to inhibition of protective arm of the host response and stimulation of destructive arm of the host response. As a result, secretion of potentially tissue destructive inflammatory mediators such as interleukin-1 (3 (IL-1 P), inter-leukin-6(IL-6), tumor necrosis factor-a (TNF- a) and matrix metalloproteinases (MMPs) are increased. In this review article periodontal manifestations and pathogenesis of periodontal diseases in HIV infected patients are addressed.