Oral manifestations in HIV-positive individuals under highly active antiretroviral therapy: a systematic review and meta-analysis of prevalence data

This study aims to analytically explore the prevalence of oral manifestations in HIV-positive patients who are receiving or are not receiving highly active antiretroviral therapy (HAART). Electronic search was conducted at multiple databases (PubMed, Embase, LILACS, SciELO, Scopus and Web of Science) and gray literature was also assessed (ProQuest and EASY databases). JBI Critical Appraisal Tools were used to establish methodological quality. Data from each study was combined in a meta-analysis of proportions using an inverse variance method, Freeman-Tukey double arcsine transformation, and Clopper-Pearson confidence interval. Quality of evidence was determined via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The search yielded 25 eligible articles, with quantitative synthesis from 13. Only four studies had a low risk of bias. The meta-analysis revealed a prevalence of oral manifestations in 42% (95% CI: 29% – 56%, I2 = 97%) of patients receiving HAART. Patients undergoing HAART were less likely to present oral manifestations (OR: 0.51; 95% CI: 0.27–0.94) than those in the non-HAART group, with a very low certainty of evidence. Although patients receiving HAART are less likely to present with oral manifestations, primary studies must be performed with a standardized methodology to guarantee results with a higher certainty of evidence.