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

Catalina Ramirez; Andrew Edmonds; Carrigan Parish; Mackenzie Vogan; Bianca Barino; Bradley Aouizerat; Todd T Brown; Kathleen M Weber; Anandi N Sheth; Gypsyamber D'Souza; Daniel Merenstein; Deborah L Jones; Maria L Alcaide; Valentina Stosor; Kara W Chew; Deepti A Janorkar; Mariana Bezamat; Deborah Gustafson; Jemima Louis; Daniel Westreich; Subhashini A Sellers; Michelle A Floris-Moore; M Bradley Drummond; Apoena A Ribeiro

doi:10.1186/s12903-026-08822-5

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

BMC Oral Health. 2026 Jun 13. doi: 10.1186/s12903-026-08822-5. Online ahead of print.

Authors

Catalina Ramirez^#¹, Andrew Edmonds^#², Carrigan Parish³, Mackenzie Vogan⁴, Bianca Barino⁴, Bradley Aouizerat^{5

6}, Todd T Brown⁷, Kathleen M Weber⁸, Anandi N Sheth⁹, Gypsyamber D'Souza¹⁰, Daniel Merenstein¹¹, Deborah L Jones¹², Maria L Alcaide¹³, Valentina Stosor¹⁴, Kara W Chew¹⁵, Deepti A Janorkar¹⁶, Mariana Bezamat¹⁷, Deborah Gustafson¹⁸, Jemima Louis¹⁹, Daniel Westreich², Subhashini A Sellers⁴, Michelle A Floris-Moore⁴, M Bradley Drummond⁴, Apoena A Ribeiro²⁰

Affiliations

¹ Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Rd. Campus Box #7030, Chapel Hill, NC, 27599-7215, USA. catalina_ramirez@med.unc.edu.
² Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, Miami, FL, USA.
⁴ Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 130 Mason Farm Rd. Campus Box #7030, Chapel Hill, NC, 27599-7215, USA.
⁵ Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY, USA.
⁶ Translational Research Center, College of Dentistry, New York University, New York, NY, USA.
⁷ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Hektoen Institute of Medicine, Chicago, IL, USA.
⁹ Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
¹⁰ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Department of Family Medicine, Georgetown University, Washington, DC, USA.
¹² Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA.
¹³ Departments of Medicine, OB/GYN, and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA.
¹⁴ Department of Medicine, Feinberg School of Medicine, Chicago, IL, USA.
¹⁵ Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
¹⁶ Department of Advanced General Dentistry, School of Dentistry, University of Mississippi Medical Center, Jackson, MS, USA.
¹⁷ Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁸ Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
¹⁹ Department of Dentistry/OMFS, Jacobi Medical Center, Bronx, NY, USA.
²⁰ Department of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

^# Contributed equally.

PMID: 42288840
DOI: 10.1186/s12903-026-08822-5

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: DMF index; Dental caries; Dental health care; HIV/AIDS; Oral health; Tooth loss.