A multidisciplinary research team composed of scientists from University of Miami and Columbia University Mailman School of Public Health will explore the links between oral and mental health in women with HIV. The collaborative study, supported by a $2.15 million five-year grant from the National Institutes of Health, is designed to provide insights that could improve overall health and quality of life for the estimated 300,000 women living with HIV in the United States.

“Interdisciplinary research will help us to understand the bidirectional relationship between mental and oral health, and the overall impact on women living with HIV,” said Carrigan Parish, DMD, PhD, assistant professor of sociomedical sciences at Columbia Mailman School of Public Health and a UM Miller School-trained epidemiologist.

As a special needs dentist, Parish specializes in access to oral health care for medically compromised and underserved individuals, including those who are HIV-positive. “By identifying critical factors in that interactive relationship, we can develop mental and oral health interventions that can benefit women over the lifespan, including during pregnancy and as they experience menopause,” she said.

Parish is one of four principal investigators in “The CROWN study: Comprehensive Research on Oral and Mental Health among WomeN,” conducted by Columbia Public Health and the Miller School of Medicine at Miami in collaboration with the University of North Carolina. The other principal investigators are Deborah Jones Weiss, PhD, professor of psychiatry and behavioral sciences and co-director of the Center for HIV and Research in Mental Health, both at Miami Miller School; Maria Alcaide, MD, professor of infectious diseases/medicine and director of clinical research at the Miami Center for AIDS Research (CFAR) clinical core; and Daniel Feaster, PhD, professor of biostatistics in the University of Miami Department of Public Health Sciences.

“This will be the first study to address the relationship between HIV, oral health and mental health over a woman’s lifespan,” said Weiss. “It is also important because poor oral health may be linked to higher risks of infections, heart disease and other problems. For example, the American Heart Association has reported that inflammation in the gums has been associated with poor heart health.”

Mental health challenges, such as depression and anxiety, are higher in women living with HIV, according to Dr. Parish and colleagues. Those issues, combined with the stresses of managing their chronic disease as well as their personal and work relationships, keep many women from seeking preventive dental treatments.

Oral health problems and unmet dental needs are common in women living with HIV, note the researchers. For instance, antiretroviral therapy (ART) can decrease salivary flow, which hinders chewing and swallowing and increases the risk of dental cavities.

“Many women also experience periodontal issues during times of change, such as pregnancy, menopause and aging,” Dr. Parish said. “By looking at women across the lifespan, we hope to gain a better understanding of the impact of those changes on mental health.”

The team of researchers will leverage data from two prior studies: STAR (Study of Treatment and Reproductive outcomes) in women of reproductive age, and MWCCS (MACS/WIHS Combined Cohort Study) in women living with HIV and at risk of HIV. These are the largest cohort studies of women living with HIV, and they address the effect of HIV on health outcomes among young (STAR) and older (MWCCS) women in the U.S.

After reviewing the data, the team will recruit 400 women (200 in Miami and 200 in North Carolina) from the Southern states in both rural and urban communities, a region home to a highly diverse population of women who face some of the greatest health disparities in the nation.

Once the women have been recruited for the study, they will be given dental assessments, including their periodontal health, plaque, cavities and other oral conditions, said Parish. As part of their initial assessment, participants will fill out questionnaires regarding dental utilization, and if their oral health is impacting their lives, such as causing difficulties in smiling, speaking or eating with others in social situations. The questionnaires will also cover mental and behavioral health issues, such as depression or anxiety.

Any women identified as having oral health issues will be referred to their dentist or to the Lindsey Hopkins Community Smiles dental clinic in Miami for care. 

Participants will return in a year for follow-up assessments and questionnaires to assess any changes in oral or mental health, as well as quality of life. “We expect the results of our research will not only provide a foundation for programs targeting oral and mental health care but shine a light on the many health disparities facing women living with HIV,” said Weiss.

“In essence, the study provides a unique opportunity to isolate the true relationships between HIV, oral health and mental health because of the existence of the comprehensive historical data on these women we now have at our fingertips,” said Feaster.

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The government can keep enforcing “Obamacare” requirements that health insurance plans cover preventative care — such as HIV prevention, some types of cancer screenings and other illnesses — while a legal battle over the mandates plays out, under a court agreement approved Tuesday.

The pact approved by the 5th U.S. Circuit Court of Appeals preserves — at least for now — cost-free preventive care coverage for millions of Americans under the Affordable Care Act.

That coverage was thrown into question by a March ruling from a federal judge in Texas, who said some of the preventive care requirements under former President Barack Obama’s 13-year-old health care law are unconstitutional.

The ruling by U.S. District Judge Reed O’Connor had nationwide effects. The Biden administration had argued last week at the appeals court that the ruling should be stayed while appeals are pursued.

The agreement was filed with the court Monday. In it, the plaintiffs in the case, including a Christian dentist who opposes coverage for contraception and HIV prevention on religious grounds, agreed to a broad stay nationwide. In return, during the appeal process, the handful of plaintiffs would be allowed to provide insurance plans that don’t include the preventive care. If O’Connor’s ruling were reversed, they would have to provide the coverage, but they would not be penalized for having dumped the coverage during appeals.

O’Connor’s March ruling deals with requirements for coverage driven by recommendations by the U.S. Preventive Services Task Force. The judge ruled that because the task force is made up of volunteers, enforcing its recommendations violates the Constitution’s Appointment Clause, which lays out how government officials can be appointed.

Not all preventive care was threatened by O’Connor’s ruling. An analysis by the nonprofit KFF foundation found that some screenings, including mammography and cervical cancer screening, would still be covered without out-of-pocket costs because the task force recommended them before the health care law was enacted in March 2010.

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