Addressing the Unique Needs of HIV-Positive Sedation Patients

With the necessary steps, you can provide safe and effective sedation for HIV-positive patients while promoting a culture of inclusivity and respect in your practice.

By Genni Burkhart

This topic is included in DOCS Education's top 25 Safety Statements, compiled by our esteemed faculty. The first ten, by Dr. Leslie Fang, can be found here

 

The first case of acquired immunodeficiency syndrome (AIDS) was recognized by the federal government forty-three years ago. Today, thanks to progress in treatment and prevention, 1.2 million Americans are living with Human Immunodeficiency Virus (HIV).

In 2021, 32,100 new HIV infections occurred in the United States, showing a reduction in diagnosed cases year over year. Yet it's estimated that 13% aren't aware and require testing.

Awareness in Dentistry

Medical developments resulting from scientific research have allowed those living with HIV an opportunity to lead healthy, fulfilling lives with less stigma than those infected in the early years of the HIV/AIDS epidemic.

Despite significant progress in the treatment of HIV/AIDS, there's still a strong need for increased awareness and education on how to support HIV-positive dental patients best.

A recent study published in Frontiers in Public Health (1) has shed light on a concerning issue - dental professionals lack experience in handling the oral health aspects of HIV infection. While this study was limited, it reflects a need for increased awareness and training in the dental community to ensure those living with HIV receive the best possible care and treatment.

The impact of HIV research on oral health cannot be overstated since these breakthroughs affect oral-systemic health. In particular, those living with HIV/AIDS are at a greater risk of developing various oral health problems due to a weakened immune system.

The National Institutes of Health (NIH) lists these higher-risk oral health problems as follows:

  • Aphthous (ulcers)
  • Hairy Leukoplakia
  • Candidiasis
  • Warts
  • Periodontitis
  • Gingivitis
  • Increased cavities
  • Dysgeusia (taste alteration)

These problems can be lessened with the development of new treatments and possible cures, including the critical use of antiretroviral therapy (ART).

Patient Privacy Vs. Patient Care

Respecting the confidentiality and autonomy of patients is essential, regardless of their HIV status.

Healthcare providers are not legally entitled to be informed of a patient's HIV status. However, patients are obligated to provide accurate information about the medications they are taking. This information is crucial as certain medications can interact with sedation drugs and impact patient safety.

Antiretroviral Drug Interactions

Dental staff must be well-versed in the names and potential interactions of HIV medications. This knowledge equips clinicians to adjust patient care and consider the possible impact of dental procedures on a compromised immune system.

Highly Active Antiretroviral Therapy (HAART) is a treatment that uses a combination of drugs to suppress the replication of HIV and lower the viral load, thereby aiding in the recovery of CD4 cell counts and improved immune function. There are various classes of antiretroviral drugs available, and HAART protocols may include one or more medications from the following drug classes:

  • Protease inhibitors (PI)
  • Nucleoside reverse transcriptase inhibitors (NRTIs)
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Integrase inhibitors
  • Fusion inhibitors

Additionally, liver metabolism and elimination of drugs can be significantly affected by HAART therapy. (2)

Some drugs used in HAART therapy can make medications stay in the body for a longer time than usual. In contrast, others can cause drugs to be eliminated from the body more quickly, resulting in higher or lower blood levels of medications. Therefore, clinicians need to be mindful of this when medicating HIV-positive patients and adjust dosages when necessary.

Commonly prescribed antibiotics for dental infections, such as amoxicillin and clindamycin, aren’t usually affected by HAART therapy. As a precaution, patients on HAART therapy should consult with their medical team before taking any medication required for dental procedures.

It's essential to have complete knowledge of all the medications a patient takes, including over-the-counter ones. This knowledge helps to ensure their safety and overall well-being. Medications should then be linked to specific medical conditions to uncover potential interactions with sedation medications.

Preventative Precautions

A significant concern regarding HIV-positive patients is their weakened immune system, which requires extra attention. While universal precautions and health histories are standard practice, caring for patients with HIV requires additional preparation.

One of the first steps in treating HIV-positive patients is to consult with their physician to establish a level of immunocompromise and acceptable medical procedures. It’s also essential to understand their history of opportunistic infections, the risk of excessive and prolonged bleeding, and immunosuppression associated with neutropenia, determined through a recent CBC with Differential.

It's important to note that even if the patient appears healthy, oral manipulation can lead to infection. People with low levels of neutrophils are especially susceptible and may need antibiotics before their dental procedure. For HIV-positive patients, the number of neutrophils is still the main factor in determining the risk of infection from dental treatments.

HIV weakens the immune system's ability to fight off infections, making it even more critical to minimize potential risks associated with sedation medications and dental procedures. Therefore, staff must follow strict infection control measures to prevent the spread of disease to and from the patient, including using appropriate protective equipment such as gloves, masks, and gowns and careful handling and disposal of medical waste.

Positive Outcomes

By shedding light on the considerations and precautions necessary to provide safe sedation to HIV-positive patients, dental professionals can effectively offer the highest level of care. Providing tailored care for these patients, including understanding their unique needs and challenges, is a testament to the dedication of a highly skilled dental team.

Dental professionals should adopt a nonjudgmental communication approach and prioritize patient well-being. Thoroughly reviewing the patient's medical history, including their medication regimen, helps identify potential interactions or concerns. Openly discussing the procedure, its implications, and the patient's unique health status fosters trust and enables tailored treatment planning.

With the necessary steps, you can provide safe and effective sedation for HIV-positive patients while promoting a culture of inclusivity and respect in your practice. Your actions, and the actions of everyone on your team, are essential in ensuring that patients feel heard, valued, and empowered regarding their oral health.

If you're not yet subscribed to receive the Incisor newsletter, filled with cutting-edge dental news sent directly to your inbox twice a month, you can do so here.

Author: With over 14 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.

 

References:

  1. Ahmed MM. Dentists and dental hygienists’ comprehension of HIV infection associated periodontal implications and management. Front Public Health. Published online April 4, 2024. doi:10.3389/fpubh.2024.1370112
  2. Little, J.W., Falace, D.A., Miller, C.S., Rhodus, N.L. AIDS, HIV Infection, and Related Conditions. Chapter 19 in Dental Management of the Medically Compromised Patient. 7th edition. Mosby Elsevier, St. Louis, MO, 2008, pp.280–301.
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