Oral health and behavioral problems in children living with and without HIV in South Africa.

The prevalence of behavioral problems in children and adolescents living with HIV is high. We investigate associations between oral microbiota and behavioral problems in children living with HIV (CLWH) and children who are HIV-uninfected (CHU). Oral swab samples, assessment of behavioral functioning using the Strengths and Difficulties Questionnaire (SDQ), and clinical and social data were collected from 477 CLWH and 123 CHU at two sites in Johannesburg, South Africa. DNA was extracted from oral swab samples and the V4 amplicon of the 16S rRNA gene sequenced. Behavioral problems were more prevalent in CLWH than in CHU, and in boys than in girls. Oral microbiota diversity and taxa abundances in CLWH did not differ between those with and without behavioral problems. In contrast, in CHU, those with behavioral problems had higher alpha diversity indices and lower abundances of Rothia and Schaalia than those without behavioral problems. Behavioral problems in CLWH were associated with being male, lower Tanner stage, less maternal education, and dental caries. Markers of poor oral health were associated with behavioral problems in CLWH, and oral microbiota profile correlated with behavioral problems in CHU. Oral health may be a preventable factor that could help reduce behavior problems in CLWH.