Dental disease among adults with and without HIV in the MACS/WIHS Combined Cohort Study (MWCCS)

Oral diseases are prevalent and linked to systemic health outcomes. People with HIV may face elevated oral disease risk, yet data on dental disease in this population remain limited. In this cross-sectional study, we analyzed oral health data collected from 2927 participants in the MACS/WIHS Combined Cohort Study (968 women with HIV [WWH], 450 women without HIV [WWoH], 941 men with HIV [MWH], 568 men without HIV [MWoH]) who had intraoral photographs collected and evaluated by dentist-researchers. We used log-binomial regression to examine associations between demographic and clinical characteristics and two outcomes: missing teeth and untreated caries or residual roots, stratified by sex. Among 2927 participants (median [interquartile range, IQR] age: WWH, 55.3 years [48.3–61.6]; WWoH, 53.3 [44.8–60.3]; MWH, 55.1 [42.6–62.9]; MWoH, 62.9 [50.1–69.5]), women experienced a higher prevalence of tooth loss and untreated decay than men. Among participants aged 65 years or older, 15% to 21% of women were edentulous (compared with 2% to 3% of men), and 30% to 31% were missing at least a full arch of teeth (compared with 4% to 6% of men). In multivariable analyses, age was a dominant predictor of missing teeth among men (age ≥ 65 vs. <45 years: adjusted prevalence ratio [aPR], 1.49; 95% confidence interval [CI], 1.29–1.73). Income was the strongest predictor of untreated decay among women, more strongly predictive than age (highest vs. lowest income: aPR, 0.11; 95% CI, 0.03–0.43). Disparities by race/ethnicity persisted among men but were absent among women, who experienced extreme poverty and poor outcomes regardless of race/ethnicity. HIV serostatus was not independently associated with either outcome. Dental disease burden in this population reflected socioeconomic disparities rather than HIV infection. Racial disparities were absent among women, who had uniformly low incomes and poor oral health outcomes across all groups, highlighting substantial barriers to dental care access that warrant policy attention.