Anti-Retroviral Therapy (ART) Affects Salivary Biomarkers in Persons Living with HIV (PLWH) and Periodontal Disease: A Narrative Review

HIV infection and antiretroviral therapy (ART) both alter the composition of saliva, which is easy to collect. This narrative review examined whether salivary biomarkers differ in persons living with HIV (PLWH) receiving ART, with and without periodontal disease (PD). We searched Pub-Med, Europe PMC, Semantic Scholar and Google Scholar for articles published between January 2010 and July 2026 and included 14 studies. Compared with HIV-negative controls, PLWH had lower salivary flow, sodium, chloride and uric acid, higher calcium and IgA, and more oxidative stress. Protein and electrolyte levels differed by ART status, and oral bacteria differed between ART regimens. Citric acid accumulated at low CD4+ T-cell counts, and metabolite profiles shifted after ART was started. Salivary Torque teno virus and several bacterial and fungal genera tracked CD4+ counts. Human β-defensin-2 (hBD-2) and secretory leukocyte protease inhibitor varied with ART status and duration. hBD-2 was associated with PD in HIV-negative individuals but not in PLWH, whereas salivary miR-324-5p tracked periodontal inflammation in PLWH on ART. Most studies were small and cross-sectional, and none identified a consistent ART-specific profile. Saliva could help monitor immune status and treatment response in PLWH, but longitudinal studies with standardized periodontal assessment are needed first.