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HIV and Dental Effects
Sep 5, 2004

I have known I am HIV+ for about 3 months. My labs have gone from 286/6,997 to 477/6,527 to 450/5,585.

I have not begun treatment yet but had been on the drug Periostat for about a year before to combat gum disease and bone loss. I remember at the time my dentist told me it looked like my immune system was turning on my body and destroying the beneficial bacteria that sustained my gums and bone.

I always thought this problem was genetic since I remember my mom having a similar problem; now I'm guessing then-undiagnosed HIV may be the culprit.

Here is my question: I worried the Periostat (which had been doing a wonderful job keeping my gums and bone stable) was working against my body's immune system so I stopped taking it. Now eight months later my dentist says my oral health is sliding again and he wants to put me back on it. I am worried because I don't know if Periostat will interfere with my immune system and give HIV a stronger hold. I can't afford to wait since my dentist says I will lose my teeth in ten years if we can't stem the bone and gum lose. What research is there for HIV+ people who may be on Periostat?

I know this is all pretty arcane, but I thank you in advance for taking a stab at it.

Response from Dr. Pierone

Periostat is an antibiotic (doxycycline) and does not lead to damage to the immune system. The main issue with long-term use of antibiotics is their tendency to alter the normal complement of bacteria that inhabit our bodies. This may occur in the mouth (a good thing is these bacteria are causing problems like in your situation), the skin, and GI tract. The changes that may evolve in the new bacterial population may include strains that are resistant to commonly used antibiotics. Periostat contains a tetracycline derivative that is fairly narrow spectrum and does not have a great tendency to lead to resistance although it may occur. Like any other form of therapy, there are trade offs that need to be weighed between intended outcomes and side effects. It seems very reasonable to continue Periostat in your case since improvement was seen when you were on it. Good luck.



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