Major dental problems go unresolved in many HIV patients

Oral infections, mouth ulcers and other severe dental conditions associated with HIV infections go untreated more than twice as often as other health problems related to the disease, a new UCLA study shows.

The study, sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) and detailed in the winter 2001 issue of the peer-reviewed Journal of Public Health Dentistry, also showed that uninsured individuals with HIV are three times more likely to have untreated dental and medical needs than those with private health insurance.

In addition, Medicaid enrollees who had state-sponsored dental coverage reported significantly more unmet dental needs than privately insured patients.

"Thousands of individuals living with HIV fail to receive dental and medical care that would help them live healthier, more productive lives," said Kevin C. Heslin of UCLA's AIDS Research Training Program, the study's lead author and a doctoral candidate in the UCLA School of Public Health. "We need to closely examine why these needs are going unmet and find better ways to provide the care that many people so desperately need. Meanwhile, state insurance programs for people with HIV should consider the feasibility of expanding their benefit structure to include dental care benefits."

Based on interviews of HIV patients in a national probability sample in 1996, the study estimates that 58,000 of the approximately 231,000 people treated for HIV that year had unmet dental or medical needs, or both.

The investigators estimated that 14.3 percent of HIV patients as a whole had unmet dental needs alone in the six months prior to being interviewed, about 6.2 percent had unmet medical needs, and 5 percent had unmet dental and medical needs combined. By comparison, data from previous studies of the general population show that 9 percent had unmet dental needs, roughly 5.7 percent had unmet medical needs, and 2.5 percent had both unmet dental and medical needs.

In addition, patients younger than age 50, the poor, the unemployed and patients living in the South were generally more likely to report having unmet dental and medical needs, as were persons of mixed race and American Indians, Eskimos, Aleuts, Pacific Islanders and Asians.

The study categorized patients as having unmet needs if they reported needing but not receiving dental or medical services in the previous six months. Although access problems may play a role, the study did not examine why needs went unmet or seek to identify specific needs.

The study is part of the HIV Cost and Services Utilization Study (HCSUS), conducted by a consortium led by RAND Health under a cooperative agreement with AHRQ. Other HHS programs that support HCSUS include the National Institute of Dental and Craniofacial Research and the Health Resources and Services Administration.

In addition to Heslin, researchers involved in the study were Dr. William E. Cunningham and Ronald M. Anderson of the UCLA School of Public Health; Dr. Marvin Marcus, Dr. James Freed and Claudia Der-Martirosian of the UCLA School of Dentistry; Ian Coulter and Sally C. Morton of Santa Monica-based RAND; Dr. Samuel A. Bozzette of the UCSD School of Medicine; and Dr. Martin F. Shapiro of the UCLA Department of General Internal Medicine.

-UCLA- DBP179