Oral Diseases (2000) 6, 395 2000 Arnold All rights reserved 1354-523X/00

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LETTER TO THE EDITOR

The Guest Editorial ‘Oral Manifestations associated withhuman immunodeficiency virus (HIV) infection indeveloping countries—are there differences fromdeveloped countries’ (Arendorf and Holmes, 2000), offeredan interesting coverage, albeit omitting some interestingconditions such as Penicilliosis marneffei, found in SouthEast Asia (Nittayananta, 1999) and first reported with oralmanifestations nearly a decade ago (Jones, 1992). However,it also raised some fundamental issues about HIV, and otheremerging diseases, which may benefit from some expan-sion.

Virtually all diseases result from an interaction ofenvironmental factors with lifestyle and genetics. HIV isthe causal agent of HIV disease and AIDS, but there are anumber of different strains reported, and possibly at leastsubtle differences in pathogenicity. Other environmentalfactors such as the prevalence of infections with HIV, STDsand opportunists, zoonoses, nutrition etc may also have aninfluence, as mentioned.

Sexual and other habits such as tobacco and other drugabuse may also have an influence, as may travel to otherareas of the globe. In addition to the influence of immuno-incompetence and antimicrobial therapy on clinical disease,there may also be genetic and perhaps ethnic differencesin host response; for example, HLA can influence suscepti-bility and resistance. Decreased HIV-1 infection risk isstrongly associated with possession of a cluster of closelyrelated HLA alleles (A2/6802 supertype), and with HLADRB1*01 (MacDonaldet al, 2000). This may also influ-ence oral disease and health; for example, it has beenreported that periodontal attachment loss in HIV is associa-ted with HLA-A1,B8, DR3 (Priceet al, 1999).

Correspondence: Professor Crispian Scully, Eastman Dental Institute forOral Health Care Sciences, International Centres for Excellence in Dentis-try and WHO Collaborating Centre for Disability, Culture and Oral Health,University College London, University of London, 256, Gray’s Inn Road,London WC1X 8LD, UK. Fax: 00 442079151039, E-mail; C.scullyKe-astman.ucl.ac.ukReceived 21 July 2000; accepted 31 July 2000

Ethnic differences can also be at play; in one USA study,the median survival of Hispanics with AIDS was signifi-cantly (P , 0.05) shorter than that of whites though sur-vival for African Americans did not differ from whites(Cunninghamet al, 2000).

C ScullyEastman Dental Institute for Oral Health Care Sciences

University College LondonUniversity of London, UK

References

Arendorf T, Holmes H (2000). Oral manifestations associatedwith human immunodeficiency virus (HIV) infection indeveloping countries—are there differences from developedcountries.Oral Dis 6: 133–135.

Cunningham WE, Mosen DM, Morales LS, Andersen RM,Shapiro MF, Hays RD (2000). Ethnic and racial differencesin long-term survival from hospitalization for HIV infection.JHealth Care Poor Underserved11: 163–178.

Jones PD, See J (1992). Penicillium marneffei infection in patientsinfected with human immunodeficiency virus; late presentationin an area of nonendemicity.Clin Infect Dis15: 744.

MacDonald KS, Fowke KR, Kimani Jet al (2000). Influence ofHLA supertypes on susceptibility and resistance to humanimmunodeficiency virus type 1 infection.J Infect Dis 181:1581–1589.

Nittayananta W (1999). Penicilliosis marneffei: another AIDSdefining illness in Southeast Asia.Oral Dis 5: 286–293.

Price P, Calder DM, Witt CSet al (1999). Periodontal attachmentloss is associated with the major histocompatibility complex 8.1haplotype (HLA-A1, B8,DR3).Tissue Antigens54: 391–399.