Robust studies needed to evaluate topical agents available to treat HIV related oral ulcers

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HIV/AIDS is currently the leading cause of death in adults in Africa and the sixth leading cause of death worldwide. In HIV infected adults, oral ulcers occur more frequently, last longer, and produce more painful symptoms than in immunocompetent people.  The aim of this review was to evaluate the efficacy and side effects of topical agents used in the treatment of HIV-related oral aphthous ulcers in adults.

The Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), AEGIS and ClinicalTrials.gov databases were searched  together with  conference proceedings from  The International AIDS Conference (IAC), The Conference on Retroviruses and Opportunistic Infections (CROI), The British HIV Association Conference (BHIVA), The International Congress on Drug Therapy in HIV infection, The Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC Conference).  Hand searches of all relevant reviews and studies were conducted and experts in the field were also contacted.  The aim was to identify randomised controlled trials in any language that evaluated the efficacy of any topical agent in treating HIV related oral aphthous ulcerations in adults.

A range of  topical agents; Antiseptic mouthwashes (eg.chlorhexidine),  Topical corticosteroids (eg  fluocinonide, triamcinolone paste, and betamethasone mouthwash ) Local analgesics,  Topical thalidomide topical sulphuric acid/phenolic solution (debacterol), Amlexanox (Aphthasol 5%) paste have been employed for this problem.  However no studies met the eligibility criteria.

Ten studies were identified that evaluated systemic rather than topical treatment (3 non-RCTs, 6 case-reports and 1 newsletter and others were conference abstracts with no full texts available).  Two studies from additional references that appeared to meet the inclusion criteria, are unpublished but attempts to obtain further information have been unsuccessful to date.

The authors concluded

 There is a need for well-designed studies to evaluate the efficacy of topical agents available for the treatment of HIV related oral ulcers.

Kuteyi T, Okwundu CI. Topical treatments for HIV-related oral ulcers. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD007975. DOI: 10.1002/14651858.CD007975.pub2

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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