OPTION 1

Diagnostic Tests in the Evaluation of the HIV Infected Patient
֍ The CD4 cell count and the viral load are the two laboratory markers that are used to monitor HIV infection.
֍ The CD4 cells are a subset of lymphocytes (synonyms are the T4 cell count or helper cells), which correlates with the patient’s immune status. The normal value for adults is 750 – 1000 cells/ml.
֍ Patients with values less than 200 cells/ml are considered to have advanced immunosuppression and are defined as having AIDS.
֍ Those with a value of less than 50 cells/ml are considered to be in a very advanced stage and are usually symptomatic.
֍ Patients with low CD4 cell counts (less than 200 cells/ml are at risk for developing the diseases associated with AIDS (opportunistic infections and cancers.
֍ Those with high counts (greater than 350 cell/ml) usually manifest no AIDS related illnesses.
Modifications of Dental Therapy
֍ There is no justification to modify dental treatment based on the fact that the patient is infected with the HIV virus.
֍ However, if the patient’s medical status is complex, treatment adjustments may be necessary as would be the case with any medically compromised patient.
֍ After performing a thorough assessment, the dentist should determine any needed treatment modifications.
֍ It is essential for all practitioners to understand that most HIV patients, even if symptomatic, can be treated safely in a typical dental office or clinic.
֍ Bleeding tendencies may determine whether or not to recommend full mouth scaling and root planning or multiple extractions in one visit.
֍ In conjunction with establishing a history of excessive bleeding and the appropriate laboratory tests, a tooth-by tooth approach to assess bleeding tendencies could be used as a clinical method to evaluate the patient’s risk of hemorrhage.
֍ In patients who are at risk for increased bleeding, deep block injections should be avoided.
֍ In these patients intraligamentary or local infiltration may be an appropriate alternative.
֍ When performing dental extractions on patients who are at risk for increased bleeding, local measures such as primary closure after surgery and the use of local thrombotic agents such as gel foam or topical thrombin are helpful in controlling the bleeding.