Dental procedures in people living with HIV: a narrative review.

Abstract

HIV affects over 39 million people globally and remains a challenge in oral health care despite advances in antiretroviral therapy (ART). The oral cavity often reflects immune status and serves as a site for opportunistic infections, making dental care essential in HIV management. This review explores four main aspects of dental care for people living with HIV (PLHIV): HIV pathophysiology, transmission risk during dental procedures, infection control strategies, and pre-treatment clinical assessment. Using the population-concept-context framework, literature was reviewed from PubMed, Scopus, and Web of Science spanning 2000-2025. Oral conditions such as candidiasis, Kaposi's sarcoma, and periodontal disease remain prevalent in PLHIV and are closely linked to HIV progression. The risk of HIV transmission in dental settings is very low (< 0.3% for percutaneous exposure) when standard precautions are followed, though stigma among providers persists. Effective infection control includes personal protective equipment, sterilization, and aerosol reduction. Pre-procedural evaluation (CD4 count, viral load, and hematological status) is vital for safe care. In cases of neutropenia, antibiotic prophylaxis may be needed, and elective procedures should be deferred. Dental treatment for PLHIV is safe when guided by evidence-based protocols. Integrating infection control, risk assessment, and personalized planning strengthens the role of dentistry in comprehensive HIV care.