Examining the Research Gap in Oral Manifestations of HIV in Paediatric Patients Receiving Antiretroviral Therapy in Nigeria

HIV oral manifestations in children change with antiretroviral therapy initiation and progression, yet the spectrum of oral lesions in Nigerian HIV-positive children on ART has not been characterised, representing a critical research gap for paediatric HIV dental care. This study examined the research gap through systematic review and original cross-sectional clinical research. A systematic scoping review of nine databases identified 47 publications on oral manifestations of HIV in children globally but only 3 specifically from Nigeria, all predating widespread ART availability. Original clinical research examined 120 HIV-positive children aged 2 to 14 years on ART and 60 HIV-negative controls at the Paediatric ART clinic of University of Abuja Teaching Hospital, Gwagwalada. Oral examination identified lesions classified by EC-Clearinghouse and WHO criteria. Oral lesions were present in 40.8 percent of HIV-positive children versus 8.3 percent of controls (p < 0.001). Oral candidiasis was the most common lesion (22.5 percent). Linear gingival erythema was identified in 14.2 percent. Salivary gland disease was present in 7.5 percent. Children with unsuppressed viral load showed significantly higher lesion prevalence. Duration of ART was inversely associated with lesion prevalence. The study identifies five priority research gaps including longitudinal lesion monitoring under different ART regimens and lesion impact on nutritional intake. Recommendations include oral lesion assessment at each ART review, paediatric dental training in HIV oral pathology, and prospective cohort studies of ART-associated oral changes. Keywords: HIV oral manifestations, paediatric ART, oral candidiasis, research gap, Nigeria